70岁以上患者冠状动脉旁路移植术

目的 总结70岁以上患者冠状动脉旁路移植术的经验,就伴发疾病的处理、手术适应证、手术技术及效果进行分析. 方法 2004年3月至2008年3月,采用冠状动脉旁路移植术治疗70岁以上高龄患者91例,年龄70～83岁.75岁以上者22例.心肺转流冠状动脉旁路移植组(CCABG组)72例,非体外循环冠状动脉旁路移植组(OPCAB组)19例.两组术前临床资料无明显差异.其中CCABG组术前植入颈动脉支架2例,肾动脉支架2例;OPCAB组植入颈动脉支架2例,肾动脉支架1例.全组左侧胸廓内动脉使用率为96.7%;CCABG组心肺转流时间(108±34)min;主动脉阻断时间(70±22)min;搭桥数(3.5±0.8)支.OPCAB组搭桥数(2.9±0.7)支. 结果 全组住院死亡2例,均为慢性阻塞性肺疾病合并肺感染.CCABG组有1例脑梗死,2例肺部感染,但与OPCAB组相比差异无统计学意义.两组在呼吸机辅助时间、ICU时间、呼吸衰竭、急性肾功能衰竭、二次开胸等方面无明显差异.但CCABG组搭桥支数高于OPCAB组(P<0.01).术后随访3～36个月,OPCAB组1例复发心绞痛,药物控制有效. 结论 处理好伴发疾病,充分再血管化,最大限度改善心肌供血,70岁以上CABG患者也可以取得满意疗效.是否在心肺转流下手术,预后并无明显差异.

Coronary artery bypass grafting in patients over 70 years old

Objective To retrospectively analyze the experiences, indications, technique, and results of coronary artery bypass grafting (CABC) in patients over 70 years old. Methods Ninety-one patients received coronary artery bypass grafting from March 2004 to March 2008. Ages ranged from 70 to 83 years old, 22 patients over 75 years old. Conventional CABG (CCABG) in 72 patients, off-pamp CABG (OPCAB) in 19 patients. Clinical data has no significant differences in two groups. The rate of using left internal mammary artery was 96. 7%. The number of grafts in CCABG and OPCAB group were 2 to 5 (3.5 ±0. 8) and 1 to 4 (2.9 ± 0. 7) respectively. Results In-hospitul death in 2 cases, both were from chronic obstructive pulmonary disease and pulmonary infection. Cerebral infarction in 1 case and pulmonary infection in 2 cases in CCABG group, but no significant difference between two groups, and no difference in intubation, ICU stay, respiratory failure, renal function failure. But number of grafts in CCABG was significantly more than that in OPCAB (P <0. 01). Postoperative follow-up was 3 to 36 months, 1 case with recurrent angina in OPCAB. Conclusions According to the characteristic of coronary artery disease in elderly, fully revascularization and improving myocardial blood supply, patients over 70 years old with CABG can obtain the same efficacy as younger patients. There were not significant difference between CCABG and OPCAB.