70岁以上高龄冠心病患者27例外科手术临床分析

Clinical analysis of surgical operations among 27 coronary heart disease patients over 70 years old

目的探讨高龄患者冠脉外科围术期管理及其外科治疗的安全性。方法回顾性分析蚌埠医学院第一附属医院心脏外科收治的2015年10月-2017年12月行冠状动脉旁路搭桥术(coronary artery bypass grafting,CABG)的70岁以上的患者27例。统计其合并症、术前准备、手术方式、手术时间、术后ICU监护时间、住院时间、术后并发症及死亡率等临床资料。结果全组患者主动脉瓣阻断时间为(106.32±45.25)min,体外循环时间为(164.95±52.43)min,术后气管插管时间为(15.8±1.6)h,移植血管数量为(2.8±0.8)根,术后留置ICU时间为(45.3±38.5)h,患者住院时间为(35.45±6.3)d,使用主动脉内气囊反搏(IABP)2例,全组术后共死亡1例,死亡原因为CABG术后低心排、急性肾功能衰竭、肺部感染。全组术后早期并发症总次数为10次,术后低心排综合征2例、恶性心律失常1例,术后急性肾功能不全1例,伤口感染1例,二次开胸止血2例,严重肺部感染2例,脑血管事件1例。结论70岁以上高龄患者的手术风险高,术后恢复差,但是在完善的术前准备、相应的手术处理方式、严密的术后监护及综合治疗基础下是安全可行的,并有积极治疗意义。

Objective To investigate the safety of surgical therapy and perioperative management of coronary heart disease patients over 70 years old.Methods The coronary artery bypass grafting(CABG)was performed in twenty-seven patients aged over 70 years old in the Department of Cardiac Surgery of the First Affiliated Hospital of Bengbu Medical College between October 2015 and December 2017.The clinical data such as complications,preoperative preparation,surgical procedure,operation time,postoperative ICU monitoring time,hospitalization time,postoperative complications and mortality were reviewed.Results The aortic valve blocking time was(106.32±45.25)min,extracorporeal circulation time was(164.95±52.43)min,the postoperative tracheal intubation time was(15.8±1.6)h,and the number of transplanted blood vessels was 2.8±0.8,the stay time in ICU after the surgery was(45.3±38.5)h,the Hospitalization time(35.45±6.3)d.The intra-aortic balloon pump(IABP)was used in 2 patients.One died from the low cardiac output,acute renal failure and pulmonary infection after coronary artery bypass graft surgery.The total number of early postoperative complications was 10 times in the group,including 2 cases of postoperative low cardiac output syndrome,1 case of malignant arrhythmia,1 case of postoperative acute renal insufficiency,1 case of wound infection,and 2 cases of rethoracotomy,2 cases of severe pulmonary infection,and 1 case of cerebrovascular event.Conclusion The surgical risk in coronary heart disease patients aged over 70 years old is high,and the patients are usually with a poor postoperative recovery.However,the surgical procedure is safe and feasible under the preoperative preparation,corresponding surgical treatment,strict postoperative monitoring and comprehensive treatment,and has a positive therapeutic significance.