老年病人冠脉搭桥手术的回顾性研究

本文对新加坡中央医院1992．1～1996．12月期间的62名75岁或以上行冠状动脉搭桥手术的病人进行了回顾性的研究。本组病人的平均年龄为77±2（75～85）岁。男女比例相同。平均搭桥3．1支。使用乳内动脉18例。使用胃网膜右动脉1例。手术成功率95％（59／62）。平均随访时间为2年。84％无症状存活；3例（5％）出院后心绞痛需药物治疗；7例（11％）于随访期间死亡：其中5例与心脏病无关，2例死于心力衰竭。因此，在熟练掌握CABG手术、谨慎选择病人的情况下，老年人行冠脉搭桥手术是安全的，其合并症和死亡率是可以接受的。

Observation on Efficacy of CABG in Aged Patients with Coronary Heart Disease

Objective To observe its value for old patients to receive CABG operation. To understand operative risks and main complication and techniques in patients aged 75 and above who underwent CABG.Methods A retrospective review of 62 patients aged 75 and above who underwent CABG during January 1992 and December 1996. The median age was 76 (range from 75 to 85 ) with equal sex distributionl. The average number of grafts was 3. 1. The internal mammary artery was used in 18 (29%) patients. The gastroepiploic artery was used in 1 (1. 5% ) patient. Results The immediate post-operative complications encountered were: 2 (3%) re-openings for low CO, 1(1.5%) re-opening for bleeding, 2(3%) perioperative infarctions, 2 (3%) mediastinitis, 2 (3%) CVAs, 2(3%) bleeding GIT, 6(10%) leg wound infections and 10 (16%) arrthymias (mostly AF).There were 3 operative deaths (1.8%) for elective CABG. The remaining 2 patients received CABG's. The mean period of follow-up was 2 years. 3(4.8%) patients had recurrence of angina and 7 died during the follow-up period. Of these, 5 had non-car-diac related causes of death. The remaining 2 died of heart failure. Conclusion Coronary artery bypass can be performed with acceptable mortality and morbidity in a caredfully selected group of elderly patient.