70岁以上高龄冠状动脉旁路移植患者的临床特征分析

目的探讨高龄因素对冠状动脉旁路移植术(CABG)治疗安全性的影响及围术期管理。方法收集2016年1月至2019年2月于首都医科大学宣武医院接受CABG治疗冠状动脉(冠脉)病变70岁以上高龄患者共71例,其中男性48例,女性23例,发病年龄为(70~83)岁,平均为(74.23±6.8)岁。按照手术方法的不同,分为停跳和不停跳两组,比较两组患者的术前、围手术期以及住院死亡的情况。结果高龄患者中,53例实施了停跳CABG治疗,18例实施了不停跳CABG治疗。高血压和糖尿病病史多见于停跳CABG治疗的患者,差异有显著统计学意义(P<0.01),其他合并症两组间均无统计学差异(P>0.05)。冠脉三支病变患者接受停跳CABG治疗比例高于不停跳CABG患者,差异有统计学意义(P<0.01)。在CABG中,使用左侧乳内动脉和完全血管重建多见于停跳CABG治疗中,差异有统计学意义(P<0.01)。胸腔积液多见于不停跳CABG治疗后的患者,差异有统计学意义(P<0.05),其他术后并发症两组之间均无统计学差异(P>0.05)。总住院时间为(19.1±7.3)d,住院死亡率为5.6%,两组之间均无统计学差异(P>0.05)。结论术前全面详尽检查,术中严密监测生命体征、维持血流动力学稳定,及早发现并处理并发症,对于高龄患者行CABG具有重要意义。

Clinical characteristics of elderly patients over 70 years old undergone coronary artery bypass grafting

Objective To discuss the influence of advanced age factor on the safety of coronary artery bypass grafting(CABG)and CABG perioperative management.Methods The elderly patients over 70 years old undergone CABG for treating coronary artery disease(n=71,male 48,female 23,disease attack age from 70 to 83 and average age=74.23±6.8)were chosen from Jan.2016 to Feb.2019.All patients were divided,according to CABG types,into on-pump CABG group and off-pump CABG group.The conditions of preoperation and perioperation and hospitalization mortality were compared between 2 groups.Results Among all patients,53 received on-pump CABG and 18 received off-pump CABG.The history of hypertension and diabetes were more common in onpump CABG group(P<0.01),and other complications had no statistical difference between 2 groups(P>0.05).The percentage of on-pump CABG was higher than that of off-pump CABG in patients with 3-vessel lesion of coronary artery(P<0.01).The applications of left internal mammary artery and complete vascular reconstruction were more common in on-pump CABG(P<0.01).The pleural effusion was more common in patients received off-pump CABG(P<0.05),and other postoperative complications had no statistical difference between 2 groups(P>0.05).The totally hospitalization time was(19.1±7.3)d and hospitalization mortality was 5.6%,and there was no statistical difference between 2 groups(P>0.05).Conclusion It is very importance for the elderly patients undergone CABG to have comprehensive and detailed preoperative examinations,closely monitor vital signs during operation,maintain hemodynamic stability and detect and manage complications as early as possible.