不停跳冠状动脉旁路移植术治疗70岁以上冠心病患者的疗效分析

Clinical effect of off-pump coronary artery bypass grafting for the patients over 70 years with coronary artery disease

目的总结 160 例不停跳冠状动脉旁路移植术治疗 70 岁以上冠状动脉粥样硬化性心脏病(冠心病)患者的临床疗效。方法 2013 年 1 月至 2017 年 12 月 160 例 70 岁以上冠心病患者均在我院行非体外循环不停跳冠状动脉旁路移植术,其中男 94 例、女 66 例,年龄 70~85(76.67±2.33)岁。采用胸骨正中切口,采用大隐静脉、乳内动脉为移植血管,使用心肌表面局部固定器、分流栓辅助完成。结果全组患者均在非体外循环下完成手术,其中应用乳内动脉桥+大隐静脉桥 62 例,全大隐静脉桥 98 例。手术均成功,无死亡病例,术后心功能明显改善,随访 1~4 年,所有患者心绞痛均明显缓解。结论不停跳冠状动脉旁路移植术治疗高龄冠心病患者疗效好,手术安全,尤其适用于肾功能不全、脑血管病、呼吸系统疾病、严重左心功能不全的患者。

Objective To evaluate the clinical efficacy of coronary artery bypass grafting in the treatment of coronary artery disease patients aged over 70 years. Methods A total of 160 patients with coronary atherosclerotic heart disease underwent off-pump coronary artery bypass grafting from January 2013 to December 2017. There were 94 males and 66 females at age of 70-85 (76.67±2.33) years. Operations were performed by using sternal median incision with the assistance of local myocardial surface fixator and shunt plug, and the saphenous vein and internal mammary arterywere used as grafted vessels. Results All the patients were received successful off-pump coronary artery bypass grafting without death, and the cardiac function improved significantly. There were 62 patients with the internal mammary artery bridge and 98 patients with the whole vein bridge. All the patients were followed-up for 1 to 4 years. All the patients had obvious relief of angina pectoris. Conclusion Off-pump coronary artery bypass grafting for the treatment of elderly patients with coronary heart disease is an effective and safe operation, especially for patients with renal insufficiency, cerebrovascular disease, respiratory disease and severe left ventricular dysfunction.