70岁以上脑卒中患者冠状动脉旁路移植术后转归分析

目的:研究70岁以上脑卒中患者冠状动脉旁路移植术(OPCABG)后恢复情况。方法:2006年1月至2009年7月,在我院完成OPCABG手术并且术前具有脑卒中史患者共437例。采集患者术前与术后资料,根据年龄将患者分成2组:≥70岁为高龄组,137例;<70岁为对照组,300例,对2组进行对照分析。结果:高龄组术前肌酐≥103 umol/L发生率明显高于对照组(P<0.05),而高龄组在糖尿病、吸烟、饮酒及体质量指数等方面明显低于对照组(P<0.05)。2组在住院时间、术后脑卒中发生率及病死率方面差异无统计学意义;而高龄组在呼吸机辅助时间≥24 h、ICU时间≥24 h、术后肌酐≥103 umol/L及术后心房颤动(房颤)发生率方面明显高于对照组(P<0.05);高龄组旁路移植数目明显低于对照组(P<0.05)。结论:70岁以上脑卒中患者冠状动脉旁路移植术后呼吸机辅助时间及ICU时间较对照组长,术后肾功能不全及房颤发生率较高。

Postoperative outcome in elderly patients with prior stroke undergoing off-pump coronary artery bypass grafting

Objective:To study the postoperative outcome in elderly patients with prior stroke undergo-ing off-pump coronary artery bypass grafting.Methods:From January 2006 to July 2009,the clinical information of 437 patients with prior stroke undergoing OPCABG in Anzhen Hospital was collected.All of the patients were divided into older age group(≥70 years old,137 patients) and control group(< 70 years old,300 patients).Preoperative and operative variants were evaluated by univariate analysis.Results:There was no difference be-tween the two groups in stroke,death after operation and the length of stay hospital.There were more patients whose ventilatory time≥24 h and ICU time≥24 h after operation in older age group than that in control group(28.1% vs.12.1%,P =0.021;43.8% vs.24.0%,P =0.013),more patients had atrial fibrillation after operation in older age group than that in control group(28.1% vs.6.7%,P < 0.001),and more patients had postoperative Cr≥103 umol/L in older age group than that in control group(40.6% vs.10.4%,P < 0.001).Conclusion:Compared with the relatively younger patients,elderly patients with prior stroke took longer to ex-tubate and stay in ICU,and they were easier to suffer atrial fibrillation and renal dysfunction after operation.