高龄冠心病患者非体外循环冠状动脉旁路移植术的临床应用

目的比较70岁以上高龄冠心病患者群中,非体外循环和体外循环两种冠脉旁路术式的近期疗效,探讨高龄冠心病的最佳手术方式。方法将170例≥70岁的冠状动脉旁路移植术者分为非体外循环冠状动脉旁路移植术组(OPCAB,n=83)和体外循环下冠状动脉旁路移植术组(CPB-CABG,n=59),回顾性分析其早期疗效。结果OPCAB组的疗效在以下方面优于CPB-CABG组(P<0.05):正性药物的使用(18.1%vs 61%),IABP的使用(8.4%vs 30.5%),围手术期心梗(3.6%vs 11.8%),急性肾衰(1.2%vs5.1%)、呼吸衰竭(9.6%vs 18.6%)、肺部感染(8.4%vs 25.4%)、脑梗死(0 vs 8.5%)、缺氧性脑病(1.2%vs6.7%)、呼吸机使用时间(12.3±5.6)vs(27.7±8.3)h,住ICU时间(2.3±1.2)vs(6.5±2.3)d,住院时间(16.4±7.1)vs(28.2±7.8)d,病死率(4.8%vs 10.2%)。结论非体外循环冠状动脉旁路移植术在高龄冠心病患者中能明显降低因为高龄而增加的手术病死率和术后并发症,应作为高龄冠心病的外科治疗首选方法;正确掌握其手术适应证、手术配合、手术技巧和围手术期处理,是确保手术疗效的关键。

Application of off-pump coronary artery bypassing in senile patients with CHD

Objective To compare the early result of OPCAB(Off-pump coronary artery bypass grafting) with CPB(cardiopulmonary bypass) CABG in senile patients with coronary heart disease(CHD),so as to find out the ideal methods for the surgery.Methods From Oct.2001 to Mar.2007,170 cases(CABG elder than 70) were divided into two groups: OPCAB group(n=80) and CPB-CABG group(n=59)(exclude 12 cases wish valve repair or replacement,ventricular septal ruptured repair,ventricular aneurysm;others 12 cases performed by on-pump beating heart technique were also excluded).The early results were analyzed respectively.Results OPCAB group was better than CPB group in these series(P<0.05): the use of positive inolropics(18.1% vs 61%),use of IABP(8.4% vs 30.5%),myocardial infarction(3.6% vs 11.8%),acute renal failure(1.2% vs 5.1%),respiration failure(9.6% vs 18.6%),use time of ventilator(12.3±5.6 vs 27.7±8.3h),ICU stay(2.3±1.2 vs 6.5±2.3d),hospital stay(16.4±7.1 vs 28.2±7.8d).Conclusion OPCAB can reduce operative mortality and complication due to senile patients obviously,it should be the first option for the surgery of senile patients with coronary heart disease;Optimal indication,operative cooperation,surgical skills and correct perioperative management are the key factors to assure surgical outcome.