非体外循环冠脉旁路术在高龄冠心病人中的应用  

Application of off-pump coronary artery bypassing in senile patients

作　　者：吴若彬[1] 郑少忆[1] 谢斌[1] 郭惠明[1] 黄劲松[1] 黄克力[1] 麦明杰[1] 罗征祥[1] 

机构地区：[1]广东省人民医院广东心血管病研究所,广东广州510100

出　　处：《岭南心血管病杂志》2005年第1期1-3,63,共4页South China Journal of Cardiovascular Diseases

基　　金：广东省科委重点引导项目:2004B35001011

摘　　要：目的比较70岁以上高龄冠心病人群中,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1999年8月至2004年5月间,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:正性药物的使用(18.1%/61%)、IABP的使用(8.4%/30.5%)、围术期心梗(3.6%/11.8%)、急性肾衰(1.2%/5.1%)、呼吸衰竭(9.6%/18.6%)、肺部感染(8.4%/25.4%)、脑梗塞(0/8.5%)、缺氧性脑病(1.2%/6.7%)、呼吸机使用时间(12.3±5.6/27.7±8.3)h、住ICU时间(2.3±1.2/6.5±2.3)d、住院时间(16.4±7.1/28.2±7.8)d、死亡率(4.8%/10.2%),各项比较P<0.05。结论非体外循环冠状动脉旁路移植术在高龄病例中能明显降低因为高龄而增加的手术死亡率和术后并发症,应作为高龄冠心病的外科治疗首选方法。Objectives 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 group, find out the ideal methods for the surgery. Methods From Aug 1999 to May 2004, 170 cases CABG elder than 70 were divided into two groups: OPCAB group(n=80) and CPB CABG group(n=59)(exclude 12 cases with 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: the use of positive inotropics (18.1%/ 61%) , use of IABP (8.4%/ 30.5%), myocardial infarction(3.6%/11.8%), acute renal failure(1.2%/5.1%), respiration failure (9.6%/18.6%), time of use ventilator (12.3±5.6h/27.7±8.3h), ICU stay (2.3±1.2days/6.5±2.3days), hospital stay (16.4±7.1days/28.2±7.8days), (p<0.05). Conclusion OPCAB reduces 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.

关 键 词：高龄 旁路术 冠脉 冠心病人 非体外循环 OPCAB 人中 人群 

分 类 号：R654[医药卫生—外科学] R541.4[医药卫生—临床医学]