70岁以上患者不停跳冠状动脉搭桥术的临床分析

Off-pump coronary artery bypass grafting in patients over the age of seventy

目的 探讨 70岁以上患者冠状动脉外科治疗的术式选择及不停跳搭桥术的安全性。方法 选择我科 1997年 9月至 2 0 0 3年 2月完成的≥ 70岁行不停跳搭桥术治疗患者 6 3例 ,分别与同期同一年龄组行单纯常规搭桥术的 94例患者及同期 <70岁行不停跳搭桥术的 5 8例患者进行比较、分析。结果 在术后正性肌力药物的使用率 (12例、19%与 34例、36 % )、输血率 (47例、75 %与 81例、86 % )、二次开胸率 (0例、0与 4例、4 % )、辅助呼吸时间 [(8± 6 )h与 (16± 12 )h]、院内病死率 (1例、2 %与 4例、4 % )等方面 ,≥ 70岁患者的不停跳搭桥术均优于常规搭桥术 ;≥ 70岁与 <70岁患者不停跳搭桥的术后并发症发生率 (19%与 19% )及院内病死率 (1例、2 %与 1例、2 % )差异无显著意义。结论 与行常规冠状动脉搭桥术的患者相比 ,高龄患者进行不停跳搭桥术有明显的优越性。对高龄患者行不停跳搭桥术 ,安全。

Objective To discuss the choice of surgical methods and the safety and efficacy of off pump coronary artery bypass grafting (OPCAB) in elderly patients. Methods From Sept.1997 to Feb.2003, 63 cases over the age of seventy (including seventy) undertook OPCAB in our department. We compared the clinical data of those patients with that of 94 cases undertook conventional coronary artery bypass grafting (CABG ) at the same age group and that of 58 cases younger than seventy received OPCAB. Results The clinical outcomes of OPCAB is better than that of CABG in elderly patients concerning inotropic drug, postoperative transfusion, re operation, intubation time, complications incidence and in hospital mortality. Furthermore, there is no significant difference of complication incidence and in hospital mortality between the elderly OPCAB group and the younger OPCAB group. Conclusions OPCAB is a safe and efficacious method of myocardial revascularization in the elderly.