高龄患者体外与非体外循环冠脉搭桥术对呼吸功能的影响

目的比较体外循环与非体外循环冠脉搭桥术对高龄患者呼吸功能的影响。方法择期行冠脉搭桥术高龄患者（>70岁）30例,其中14例行常规体外循环下冠脉搭桥术;16例行非体外循环冠脉搭桥术。测定两组手术前后不同时点呼吸功能指标动脉血氧含量（CaO2）和术后氧合指数（OI）,呼吸机支持时间,气管插管拔除后24h内自主呼吸频率和呼吸情况。结果两组术后各时点CaO2均较术前显著下降（P<0.05）,OI相应时点较术前显著增高。非体外循环冠脉搭桥术组术后各时点CaO2明显高于常规体外循环下冠脉搭桥术组（P<0.05）,而非体外循环冠脉搭桥术组术后各时点的OI值均显著低于常规体外循环下冠脉搭桥术组（P<0.05）,非体外循环冠脉搭桥术组呼吸机支持时间较短（P<0.05）,气管插管拔除后自主呼吸频率较平稳（P<0.05）。结论大于70岁患者行冠脉搭桥术其呼吸功能均受影响,非体外循环冠脉搭桥术对呼吸功能影响较小,优点较多,更适合高龄患者。

Effect of on-pump and off-pump coronary artery bypass grafting on respiratory function in the over 70-years old patients

AIM To compare the effects of on-pump and off-pump coronary artery bypass grafting (CABG) on respiratory function in patients older than 70 years. METHODS Of 30 patients (>70 years), 14 underwent on-pump (CCABG) and 16 off-pump (OPCABG ) . CaO_ 2 and OI were detected before and after surgery. Ventilation time, simultaneous breath frequency within 24 hours after extubation were also observed. RESULT Postoperatively CaO_ 2 decreased and OI increased respectively in two groups(P<0.05). But in OPCABG group, CaO_ 2 at 48 h and OI at 3 h post-operation had no significant changes compared with pre-operation. Postoperative OI was obviously lower (P<0.05) and CaO_ 2 significantly higher(P<0.05)in OPCABG group than in CCABG group. OPCABG group had a shorter ventilation time and lower(P<0.05) simultaneous breath frequency in 6 h post-operation. CONCLUSION The respiratory function decreases after CABG in patients older than 70 years. OPCABG has less effects on respiratory function compared with CCABG and therefore beneficial to older patients.