老年患者体外与非体外循环行冠状动脉旁路移植术对围术期血气的影响

目的比较非体外循环（off-pump）和体外循环（on-pump）冠状动脉旁路移植手术（CABG）对年龄大于65岁老年患者围术期血气的影响。方法32例患者接受CABG手术,其中16例采用off-pump,16例采用传统的on-pump,收集两组患者术前肺功能、手术时间、旁路移植血管数、气管插管留置时间和ICU留住时间。测定患者术前、手术开始、手术结束时和术后24、48、72 h的动脉血气。结果两组患者术前肺功能、手术时间、旁路移植血管数无明显差异,但off-pump组的气管插管留置时间和ICU留住时间均明显短于on-pump组（P<0.05）。两组患者术前、手术开始和术后48、72 h的动脉血气相似,但是手术结束时on-pump组PaO2和红细胞压积（Hct）明显低于off-pump组（P<0.05）;术后24 h on-pump组PaO2仍显著低于off-pump组（P<0.05）。结论与传统的on-pump CABG相比,off-pump可改善年龄大于65岁老年患者术后早期的血气,并能缩短ICU留住时间。

Effect of on-pump and off-pump coronary bypass surgery on perioperative blood gases in elderly patients

AIM To compare the effects of on-pump and off-pump coronary bypass surgery on blood gases in patients over 65 years.METHODS Sixteen patients in on-pump group underwent coronary artery bypass graft(CABG) with cardiopulmonary bypass(CPB) and the other 16 patients in off-pump group without CPB.Respiratory function test and arterial blood gas analyses were performed preoperatively.Duration of operation,number of grafts and length of ICU stay was recorded.Arterial blood gas at the onset of operation,at the end of operation and 24 h,48 h and 72 h after operation were measured.(RESULTS) There was no significant difference in demographic data,surgical characteristics and preoperative respiratory function between two groups.However,the length of intubation and ICU stay were shorter in off-pump group than in on-pump group(P<0.05).The arterial blood gas analyses before operation,at the onset of operation,48 h and 72 h after operation were not significantly different between two groups.PaO_2 and Hct at the end of operation in on-pump group were lower compared with off-pump group(P<0.05).PaO_2 in on-pump group remained lower 24 h after operation than that in off-pump group(P<(0.05)).CONCLUSION Off-pump technique may help to improve arterial blood gases shortly after operation and respiratory functions in patients over 65 years undergoing CABG and thus shorten intubation time and length of ICU stay.