70岁以上高龄患者冠心病的外科治疗

The surgical therapy of senile patients over the age of 70 with coronary heart disease

目的 比较 41例 70岁以上高龄冠心病患者两种手术方法的治疗结果。方法 回顾性分析 2 0 0 0年 12月至 2 0 0 2年 1月间 41例冠状动脉旁路移植术病例 ,分为非体外循环下和体外循环下冠状动脉旁路移植术两组 ,前组 17例 ,采用胸骨正中切口 ,在非体外循环下完成手术 ;后组2 4例 ,常规建立体外循环 ,在心脏停跳下完成手术。结果 两组间性别、年龄、陈旧性心肌梗塞病史、不稳定性心绞痛、合并高血压和高脂血症 ,平均每例冠状动脉病变等无统计学差异 ,但平均每例旁路移植分别为 2 .1支与 3 .2支 ,差异显著 (P <0 .0 5 )。两组均无手术死亡。随访 1～ 11个月 ,前组 2例 (11.8% ) ,后组 3例 (12 .5 % )复发心绞痛 ,两组病例随访期间均无死亡。结论 非体外循环下冠状动脉旁路移植术安全可行 ,近期疗效确切 ,有一定的优越性 。

Objective To evaluate the results of coronary artery bypass grafting in forty-one senile cases no less than seventy years old with coronary heart disease. Method Retrospectively analyzed the operative results of 41 cases of CABGs (17-case of OPCABs and 24-case of conventional CABGs(CCABGs))with the age no less than 70 years old from Dec.20 2000 to Jan.31 2002.Results The average bypass grafts per patient was 2.1±0.6 in OPCAB group and 3.4±0.7 in CCABG group(P<0.05). There was no operative death. Followed-up for 1～11 months, the recurrent rate of angina pectoris in OPCAB was 11.8% and in CCABG was 12.5%.Conclusions OPCAB procedure is a practicable, safe alternative to CCABG.Compared with CCABG, OPCAB shows some advantages, but cannot replace CCABG.