非体外循环冠状动脉旁路移植术在老年冠心病患者中的应用

Application effects of off-pump coronary artery bypass grafting for elderly patients with coronary heart disease

目的探讨非体外循环冠状动脉旁路移植术治疗老年冠心病患者的临床疗效,分析其可行性及安全性。方法我院2007年1月至2012年1月收治248例60岁以上的冠状动脉硬化性心脏病患者,术前均拟定行非体外循环冠状动脉旁路移植术。将患者按照年龄分为60~70岁组（92例）和70岁以上组（84例）,观察2组移植血管数量、主动脉内球囊反搏的使用、呼吸机辅助时间、术后住院时间、术后输血量、术后并发症、术后病死率等情况。结果与60~70岁组比较,70岁以上组呼吸机辅助时间明显较长、术后输血量较大,2组比较差异具有统计学意义（P〈0.05）,2组移植血管数量、主动脉内球囊反搏使用率、术后住院时间、并发症发生率及病死率等比较差异无统计学意义（P〉0.05）。结论非外循环冠状动脉旁路移植术应用于老年冠心病患者的治疗中是安全可行的,老年并不能作为该术式的禁忌证。

Objective To explore the application effect,feasibility and security of off-pump coronary artery bypass grafting for elderly patients with coronary arteriosclerotic cardiopathy. Methods Totally 248 cases patients with coronary arteriosclerotic cardiopathy who aged over 60 years old were planned to conduct off-pump coronary artery bypass grafting preoperatively in our hospital from January 2007 to January2012. Divided the 248 patients into two groups according to their age,namely aged 60 to 70 years old group（ 92 cases） and aged over 70 years old group（ 84 cases）. Observed the amount of grafted vessels,usage rate of intra-aortic balloon pump,time of assisted breathing with ventilator,post-operation hospitalization duration,postoperative blood transfusion volume,complications and fatality rate after operation.Results Compared with aged 60 to 70 years old group,patients aged over 70 years old need more time of assisted breathing with ventilator（ P 〈 0. 05） and more postoperative blood transfusion volume（ P 〈 0. 05）. But there was no significant difference in terms of amount of grafted vessels,usage rate of intra-aortic balloon pump,post-operation hospitalization duration,complications and fatality rate after operation（ P 〉 0. 05）. Conclusion Off-pump coronary artery bypass grafting applied in treatment of coronary heart disease for elderly patients is safe and feasible,and advanced in years is not a contraindication for this method.