高龄患者非体外和体外循环冠状动脉旁路移植术临床分析

Clinical analysis of off-pump and extracorporeal bypass coronary artery bypass grafting in elderly patients

目的通过比较年龄≥70岁高龄患者体外循环冠状动脉旁路移植术(CCABG)和非体外循环冠状动脉旁路移植术(OPCABG)围手术期各项临床指标,分析两种手术方法的效果,为临床高龄患者手术方式的选择提供指导,进一步降低手术患者的并发症发生率和死亡率。方法回顾性分析2014年1月‐2017年6月在该院行冠状动脉旁路移植术32例年龄≥70岁高龄冠状动脉粥样硬化性心脏病(冠心病)患者的临床资料,其中应用体外循环14例,非体外循环18例;对两组患者的术前各项指标及术后临床资料进行统计分析比较。结果 OPCABG组患者的手术时间、术后引流量>600 ml、呼吸辅助时间>24 h、正性肌力药物使用时间>36 h者均少于或者低于CCABG组(P<0.05)。结论对于70岁以上的高龄冠心病患者行冠状动脉旁路移植术(CABG)是安全可行的。OPCABG和CCABG比较,OPCABG具有手术时间短、呼吸机辅助呼吸时间短、术后引流量少及血管正性肌力药物使用时间短等优点。

【Objective】To compare the perioperative clinical indicators of patients aged ≥ 70 years undergoing conventional coronary artery bypass grafting（CCABG） or off-pump coronary artery bypass grafting（OPCABG）, to analyze the effect of two surgical methods, to provide guidance for elderly patients in clinical choice of surgical approach, and to further reduce the incidence of complications and mortality.【Methods】Clinical data of 32 elderly patients with coronary heart disease aged ≥ 70 years who underwent coronary artery bypass grafting from January 2014 to June 2017 in our hospital were retrospectively analyzed, extracorporeal circulation was conducted in 14 cases, and off-pump was conducted in 18 cases; preoperative indicators and postoperative clinical data of patients in the two groups were statistically analyzed and compared.【Results】The operative time（min）, postoperative drainage 〈600 ml, respiratory assist time 〉24 h and service time of positive inotropic drugs 〉36 h in OPCABG group were less than those in CCABG group（P〈0.05）.【Conclusion】Coronary artery bypass grafting（CABG） is safe and feasible for elderly patients with coronary heart disease over 70 years of age. Compared with CCABG, OPCABG has the advantages of short operation time, short respirator assisted breathing time, less postoperative drainage and short service time of positive inotropic drug.