70歲以上病人冠狀動脈旁路移植術療效分析

Clinical analysis of coronary artery bypass grafting in the group of patients over 70 years of age

目的探討70歲以上高齡病人行冠狀動脈旁路移植術(CABG)的臨床效果。方法自1993年6月至2010年12月,本院共爲55例70歲以上高齡病人行CABG術,其中男性38例,女性17例,年齡70~86歲,平均74.89±3.63。行停跳(On-pump)CABG28例,不停跳(Off-pump)CABG27例。分別行搭橋1~6根,平均2.87±1.03根。39例病人應用乳内動脈搭橋。同期行室壁瘤切除加左室成形術4例,瓣膜手術9例。結果圍術期死亡6例,死亡率爲10.9%。術後發生併發症包括低心排綜合征11例,術中及術後應用主動脈内球囊反搏(IABP)7例。呼吸功能不全7例(4例行氣管切開),急性腎衰5例(4例行持續性腎臟替代治療)。平均ICU滯留天數爲7.91±7.63天,平均術後住院天數爲39.01±31.20天。結論70歲以上高齡病人行CABG術是可行的,手術仍有較高死亡率。術前應加强對心肺等重要臟器功能的判斷,術後積極處理和預防併發症的發生,以進一步降低死亡率。

Objective The purpose of this study was to assess the clinical result of coronary artery bypass grafting(CABG)in the group of patients(pts)over 70 years of age.Methods Between June 1993 to December 2010,55 pts over 70 years of age underwent CABG.Thirty eight male and 17 female pts,average age 70~86,were operated.From this group,28 on-pump CABG and 27 off-pump CABG were studied.Of which 1~6 grafts were bypassed each case,average 2.87±1.03 grafts per pts.Left internal mammary graft had been used for bypass in 39 cases.Left ventricular aneurysmotomy plus surgical ventricular restoration had been done in four cases and valve surgery had been done in nine cases simultaneously.Results Six patients died,the perioperative mortality was 10.9%.Postoperative complications including low cardiac output syndrome,which was happened in 11 cases,and in which intraaortic balloon pump(IABP)was used in 7 cases during or after operation.Respiratory failure was seen in 7 pts(4 pts need tracheostomy),acute renal failure in 5 pts(4 pts need continuous renal replacement therapy).Average ICU stay was 7.91±7.63 days,and average postoperative stay was 39.01±31.20 days.Conclusion Although the mortality rate was quite high,surgery for patients over 70 years old still is feasible.In order to lower the mortality rate and complication rate,it is important to reinforce preoperative assessment of some important organs function,especially the heart and lung function,and to promptly manage post-operative complication.