老年冠心病患者非体外循环冠状动脉搭桥术25例

目的 总结25例老年（≥70岁）冠心病患者非体外循环冠状动脉搭桥术（OPCABG）的临床体会.方法 回顾性分析我院2007年7月至2013年11月经OPCABG治疗的25例老年冠心病患者的临床资料.结果 全组手术均获成功.无手术死亡,无中转体外循环完成手术者,围手术期死亡率0,无围手术期心肌梗死及神经系统并发症.全组应用左乳内动脉（IMA）和大隐静脉（SVG）搭桥77支,平均（3.1±1.0）支,行左乳内动脉与前降支吻合20例（80％）,大隐静脉搭桥24例（96％）,共57支,包括左乳内动脉（IMA）和大隐静脉（SVG）搭桥19例（79％）41支,完全静脉桥5例（20％）16支,其中序贯静脉桥14例（56％）18支.术后低心排综合征3例,应用IABP 1例,术后出现肺部并发症5例,呼吸衰竭2例,开胸止血1例,伤口感染1例.不稳定型心绞痛者,除2例术后无缓解,后经PTCA治疗有所缓解外,大部分手术后完全缓解.心功能不全者术后逐渐得到纠正,心功能Ⅰ～Ⅱ级.术后随访3～60个月,随访期间除1例死于心肌再梗死,1例死于肝癌外,大部分患者生活质量明显改善.结论 老年冠心病患者行OPCABG是一种安全、有效的方法,特别是对一些左主干病变、三支病变、合并心功能及其他重要脏器功能不全患者是一种更具优势的方法.

25 cases of elderly patients with off-pump coronary artery bypass grafting surgery

Objective To summarize the clinical experience of off-pump coronary artery bypass graft surgery（OPCAB） on 25 aged patients（older than 70yr） with coronary heat disease（CHD）.Methods Retrospective analysis of the clinical data of the 25 cases of OPCAB on elderly CHD patients from July 2007 to November 2013 in our center.Results All operations were successful with no operative death,nor transfer to on-pump CABG.All of the rate of perioperative mortality,perioperative myocardial infarction and neurological complications was zero.Of all the cases,there were 20 LIMA-LAD grafts and 57 SVG grafts,with （3.1±1.0）grafts for each case.Both the LIMA-LAD and SVG grafts （41 grafts totally） were utilized in 19 cases （79％）,and total venous grafts （16 grafts） were used in 5 cases （20％）.Sequential SVG graft anastomosis （18 grafts） was applied in 14 cases （56％）.The postoperative complications included low cardiac output syndrome in 3 cases,the application of IABP in 1 case,pulmonary complications in 5 cases,respiratory failure in 2 cases,bleeding in 1 case,and chest wound infection in 1 case.Patients with unstable angina,except for 2 cases,in which the symptoms were released after PTCA postoperatively,were complete free from chest pain after the operation.And the patients with preoperative cardiac insufficiency improved with their cardiac function to Level Ⅰ-Ⅱ （NYHA Class）.The duration of the postoperative follow-up was 3 to 60 months.Most of the patients＇ quality of life improved significantly,except 1 case died of myocardial infarction and the other case died of liver cancer.Conclusion For elderly patients with coronary heart disease,OPCAB is a safe and effective method,especially for those cases with left main lesion,triple vessel lesions,and combining with cardiac dysfunction and/or other important organ dysfunction,which is of more advantage.