75岁以上老年人两种冠脉搭桥法效果比较

Comparation of two different methods in coronary artery bypass grafting in 75 years age and older

目的比较75岁及以上老年人体外循环和非体外循环下冠脉搭桥术后的相关数据，明确两种手术对患者手术后早、中期的影响（2年内），为临床选择提供经验。方法比较青岛阜外心血管病医院2010年10月到2013年5月期间接受冠脉搭桥手术的75岁及以上患者围术期及术后随访数据，分为体外循环组42例，非体外循环组68例，比较两组数据有无显著性差别。结果两组病例术前左心室射血分数[（51．0±6．3）％比（50．0±7．6）％，P=0．427]和左心室舒张末期直径[（52．0±6．1）mm比（51．0±5．7）mm，P=0．752]无明显差别；手术操作时间[（3．7±0．9）h比（3．3±0．3）h，P=0．242]、远端吻合口数[（3．3±0．9）比（3．1±0．6），P=0．304]、术后住院时间[（10．9±3．1）d比（11．1±3．7）d，P=0．548]无明显差别；术后两组呼吸机辅助呼吸时间[（20．3±5．0）h比（13．8±5．7）h，P=0．038]、ICU居住时间[（87．6±19．2）h比（73．9±17．8）h，P=0．021]、术后输注红细胞量[（1．9±0．4）U比（0．7±0．6）U，P=0．035]及输血浆量[（320±121）ml比（180±88）ml，P=0．012]比较差异有统计学意义。术后3至6个月复查心脏彩超显示，左心室射血分数[（53．0±8．1）％比（51．0±9．6）％，P=0．560]和左心室舒张末期直径[（47．0±11．3）mm比（49．0±10．2）mm，P=0．376]未见统计学差异。两组患者术后1年、2年内心功能分级、全因死亡率、心血管事件再次入院比率未见统计学差异。结论通过术后早、中期（2年）的临床资料比较，两种冠脉搭桥方法对75岁以上老年人均安全、有效。

Objective To compare the early and middle outcomes（2 years postoperation） in 75 years age and older population undengoing coronary artery bypass grafting （CABG） with and without cardiopulmonary bypass （CPB）. Methods From 2010 to 2013, CABG was performed in patients, including 42 with CPB（conventional CABG, CCAB） and 68 without CPB （off-pump CABG, OPCAB）. The outcomes were compared between two groups. Results No significant difference was found in preoperative left ventricular ejection fraction[（51.0±6.3）% vs （50.0±7.6）%, P=0.427], left ventricular end-diastolic diameter [（52.0±6.1）mm vs （51.0±5.7）mm, P= 0.752 ], operation time [ （3.7±0.9）h vs （3.3±0.3）h, P=0.242 ], postoperative in-hospital stay [ （ 10.9±3.1 ）d vs （11.1±3.7）d, P=0.548], and bypass grafts[（3.3±0.9） vs （3.1±0.6）, P=0.30d] in two groups. Average ventilator [ （20.3±5.0）h vs （ 13.8±5.7 ）h, P=0.038 ], intensive care unit stay [ （ 87.6± 19.2）h vs （73.9± 17.8 ）h, P=0.021 ], red cell transfusion [（1.9±0.4）U vs （0.7±0.6）U, P=0.035], and blood plasma transfusion [（320±121）ml vs （180±88）ml, P=0.O12] had significant difference between two groups. 3 to 6 months after operation, there was no significant difference in postoperative LVEF[（53.0±8.1）% vs （51.0±9.6）%, P=0.560], LVDD[（47.0±11.3） mm vs （49.0±10.2）mm, P=0.376]. Within 1 years after surgery, no difference were found in readmission rate of cardiovascular events and all cause mortality in two groups. Conclusion In 75 years age and older, CCAB surgery and OPCAB surgery are same safe and effective methods in early and middle outcomes （2 year after operation ）.