分站式Hybrid杂交手术治疗冠状动脉多支病变高龄患者的短期疗效分析

Early outcomes of two-stage Hybrid surgery in patients aged over 80 years with multivessel coronary artery disease

目的探讨分站式Hybrid杂交手术对80岁以上冠状动脉多支病变患者围术期疗效及心血管不良事件发生率的影响。方法回顾性分析2006年1月至2013年12月我院67例80岁以上高龄冠状动脉多支病变患者的临床资料,其中男44例、女23例,平均年龄(82.4±2.1)岁。根据手术方式的不同,将患者分为分站式Hybrid杂交手术组[29例,男19例、女10例,平均年龄(83.2±3.1)岁]和传统开胸手术组[38例,男25例、女13例,平均年龄(83.3±3.4)岁],比较两组患者围术期临床结果。结果 80岁以上患者分站式Hybrid杂交手术与传统开胸手术组相比,其机械通气时间[(6.7±2.2)h vs.(18.2±3.4)h]、术后总住院时间[(15.7±3.0)d vs.(20.7±5.6)d]明显缩短,术后24 h引流量[(176.5±32.3)ml vs.(443.8±51.5)ml]明显减少,差异有统计学意义(P均<0.05)。两组患者围术期不良事件发生率差异有统计学意义(6.9%vs.23.1%,P<0.05)。结论分站式Hybrid杂交手术能明显降低80岁以上高龄冠状动脉多支病变患者围术期心血管不良事件发生率,缩短术后住院时间和术后机械通气时间,减少术后24 h引流量,改善高龄患者手术预后。

Objective To observe the short-term efficacy and the incidence of adverse cardiovascular events in patients aged over 80 years with multivessel coronary artery disease following two-stage Hybrid surgery. Methods We retrospectively analysed the clinical data of 67 patients aged over 80 years with multivessel coronary artery disease undergoing surgery in our hospital. The were 44 males and 23 females with an anverage age of 82.4±2.1 years. According to the operation pattern, the patients were divided into two groups： a two-stage Hybrid surgery group （n=29, 19 males, 10 females, aged 83.2±3.1 years） and a traditional thoracotomy group （n=38, 25 males, 13 females, aged 83.3±3.4 years）. We compared the clinical results ofperioperation between the two groups. Results Conpared with the traditional thoracotomy group, the two-stage Hybrid surgery group had shorter postoperative duration of mechanical ventilation （6.7±2.2 h vs. 18.2±3.4 h） and hospitalization stay （15.7±3.0 d vs. 20.7±5.6 d） and had less volume of chest drainage during the first 24 h after surgery （176.5±32.3 ml vs. 443.8±51.5 ml）. The incidence of adverse cardiovascular events in the two- stage Hybrid surgery group was significantly lower than that in the traditional thoracotomy group （6.9% vs. 23.1%, P〈0.05）. Conclusion The two-stage Hybrid surgery in patients aged over 80 years with multivessel coronary artery disease can significantly decrease the postoperative incidence of adverse cardiovascular events, shorten the postoperative duration of mechanical ventilation and hospitalization stay, reduce the volume of chest drainage during the first 24 h after surgery and improve prognosis of surgery for the elderly patients.