高龄糖尿病病人的冠状动脉旁路移植术  

Outcomes of coronary artery bypass grafting in old patients with diabetes

作　　者：庄瑜[1] 肖明第[1] 袁忠祥[1] 卢成宝[1] 林雷[1] 虞敏[1] 毛建强[1] 

机构地区：[1]上海交通大学附属第一人民医院心血管外科,200080

出　　处：《中华胸心血管外科杂志》2010年第1期37-40,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的分析高龄糖尿病病人行冠状动脉旁路移植术的疗效，探讨糖尿病对高龄冠状动脉旁路手术病人的影响。方法649例70岁以上冠脉旁路移植病人分成糖尿病组及无糖尿病组。统计分析两组术前、术中及术后资料。结果除糖尿病组合并左主干病变较多外，两组术前病情及手术情况未见差异，术后病死率、并发症、输血等各方面差异也未见统计学意义。结论高龄病人行冠状动脉旁路移植手术是可行的，糖尿病病人可以获得与非糖尿病者相同的治疗效果。Objective The risk for coronary artery bypass surgery is reported to be increased with age and associated with diabetes. We examined the outcomes of coronary artery bypass grafting （CABG） in patients with diabetes who were older than 70 years of age and evaluate the effect of diabetes on CABG in those patients. Methods From March 2000 to March 2008, the data of 649 patients older than 70 years of age were collected retrospectively and divided into diabetic group or non- diabetic group based on pre-operative diagnosis. The blood glucose level of patients was maintained between 7.0 mmol/L （ 126 mg/dl） and 10.0 mmol/L （ 180 mg/dl） perioperatively. Stata 7.0 was used for statistical analysis. The t test andχ^2 test were used to determine the differences in the numerical variables and categorical variables respectively. Results No statistical differences were observed between the two groups in the baseline variables, such as age [ （ 74.78 ±3.67） years for diabetic group vs. （ 75.00 ±3.65 ） years for non-diabetic group, P = 0. 4877 ] , female patients （ 34.76% vs. 29.22%, P = 0. 1663）, ejection fraction [ （ 57.02 ±10.10 ） % vs. （ 58.49 ±10.39 ） %, P = 0. 1004 ） ] , myocardial infarction history （26.20% vs. 28.35%, P =0. 5795）, though there were more left main diseases in the diabetic group （52.41% vs. 26.41%, diabetic vs. non-diabetic, P = 0. 0000 ）. The overall in-hospital mortality was 6.32% （ 8.02% in the diabetic group vs. 5.63 % in the non-diabetic group, P = 0. 2571 ）. The main causes of death were sudden respiratory and cardiac arrest, low cardiac output syndrome （LCOS）, malignant arrhythmia, respiratory failure, renal failure, central nervous system compli- cations, and multiple organ failure. Major post-operative complications were bleeding, atrial fibrillation, plural effusion and pulmonary infection. Post-operative variables, such as EF （0.59 ±0.13 in the diabetic group vs. 0.61 ±0.15 in the non-dia- betic group, P =0. 1807）, re-revascularization d

关 键 词：冠状动脉分流术 糖尿病 预后 

分 类 号：R654.2[医药卫生—外科学]