老年冠心病的外科治疗  

Surgical treatment in aged patients with coronary heart disease

作　　者：姬尚义[1] 杨建安[1] 王志伟[1] 谭敏[1] 陈长春[1] 张玉萍 

机构地区：[1]深圳市孙逸仙心血管医院深圳市心血管病研究所,广东省深圳市518020 [2]深圳市保健办

出　　处：《中国心血管病研究》2005年第10期754-756,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的总结老年冠心患者的外科治疗经验。方法选择2000年1月至2004年10月间146例≥70岁的冠状动脉旁路移植术(CABG)患者,男性114例,女性32例,年龄70～84(72.9±4.1)岁。术前心功能Ⅱ级55例,Ⅲ级62例,Ⅳ级29例;LVEF18%～69%,<30%49例,30%～50%90例,>50%7例。术前合并高血压病29例,合并糖尿病30例,有心肌梗死史28例,合并瓣膜病21例,合并室壁瘤11例,合并心腔内黏液瘤2例,合并室壁瘤+室间隔穿孔1例,冠状动脉造影单支病变15例,2支病变29例,3支及以上病变102例;15例患者行单支CABG,29例2支桥,3支桥58例,4支桥41例,5支2例,6支1例,人均2.9支桥。合并其他心脏病变者均在CABG的同期行矫治手术。结果死亡7例。死亡原因:低心排3例,突发心室纤颤2例,心包填塞1例,肾功能衰竭1例。随访126例,随访时间1～52(26.7±7.8)个月。晚期死亡6例,死亡原因:肿瘤3例,车祸1例,猝死1例,原因不明1例。本组患者术后有59人发生各种不同并发症,发生率为40.4%。结论老年是CABG的独立危险因素,且术后并发症发生率高,但只要处理适当,95%左右的老年冠心病患者还是可通过CABG延长生命,提高生活质量的。Objective To summarize the experience of the surgical treatment in aged patients with coronary atherosclerotic heart disease. Methods 146 patients （age≥70 years old） were surgical treated from Jan. 2000 to Oct. 2004. Amoung them, there were 114 males and 32 females. The age were from 70 to 84 years old （average 72.9±4.1）. Preoperation heart function in grade Ⅱ were 55 cases, grade Ⅲ and Ⅵ were 62 cases and 29 cases.Preoperation LVEF were from 18% to 69%. There were 49 patients less than 30%,90 cases 30% to 50%, and 7 cses grater than 50%.There were 29 patients accompanied with hypertension,diabetes in 30 cases, myocardial infuction in 28 cases, valvular disease in 21 cases, myocardial anuerysum in 11 cases, myxoma in 2 cases, and anuerysum plus ischemic VSD. In one case. Coronary artery lesion： one branch lesion in 15 cases, two branches lesion in 29 cases,three or more branches lesion in 102 cases. Patient recievced one bypass graft in 15 cases, two in 29, three in 58, four in41, five in 2 and six in one case. The average was 2.9 grafts. All the other heart disease were surgical treated at the same time. Results There were 7 patients died perioperation. The mortality was 4.8%.59 patients had vary complicatiom and the incidence was 40.4%. 126 patients were followed up. The follow-up time were from one month to 52 monthes （26.7±7.8 monthes）.There were 6 late death and the incidence was 4.8%. Conclusion The age is an indepandence risk factor for CABG. The older patients have higher complication incidence. But most （95%） aged patients still can get benefit from the CABG precedure and have longevity, better life quality.

关 键 词：冠状动脉分流术 老年人 危险因素 

分 类 号：R654.2[医药卫生—外科学]