70岁及以上冠状动脉旁路移植患者临床特征分析  

Analysis of clinical characters in old patients undergoing coronary artery bypass grafting

作　　者：王湘[1] 陈长春[1] 李刚[1] 杨建安[1] 曾丽[2] 刘希玲[2] 姬尚义[1] 

机构地区：[1]孙逸仙心血管医院心外科,深圳518020 [2]孙逸仙心血管医院重症监护病房

出　　处：《中华老年医学杂志》2011年第3期192-194,共3页Chinese Journal of Geriatrics

基　　金：深圳市科技局立项课题（200803113）

摘　　要：目的观察70岁及以上冠状动脉旁路移植术（CABG）患者的手术危险因素特点及手术效果。方法回顾分析我院2000年1月至2009年4月施行CABG的426例患者的临床资料，其中70～82岁组118例，24～69岁组308例，将两组患者手术危险因素、并发症及手术效果进行对比研究。结果70～82岁组术前危险因素为女性、慢性阻塞性肺疾病、外周血管病变、心功能Ⅳ级、需静脉硝酸甘油治疗的不稳定心绞痛、左心室射血分数〈30%的比例、术后严重并发症的发生率、手术病死率、移植血管数和在重症监护病房时间均较24～69岁组高（P〈O．05）；70～82岁组患者并存瓣膜病变和采用左乳内动脉桥较24～69岁组少，分别为16例（13．6％）和152例（49．4％），差异有统计学意义（P〈O．05）。结论我国70岁及以上患者手术危险因素组成特点与国外有区别，尽管施行CABG严重并发症发生率和手术病死率较高，但并未明显延长患者的手术恢复时间。Objective To analyze the clinical characters in old patients undergoing coronary artery bypass grafting （CABG）. Methods The clinical data of 426 patients undergoing CABG from January 2000 to April 2009 in our hospital were retrospectively analyzed. One hundred eighteen patients were 70-82 years old （older group）, 308 patients were 24-69 years old （younger group）. The perioperative risk factors, surgical complication and outcomes between the two groups were compared. Results Ti^e older group had higher incidences of post-operative complications than younger group. Pre-operative risk factors included the female, chronic obstructive pulmonary disease, peripheral vessel disease, New york heart association（NYHA） class IV, unstable angina requiring intravenous nitrates until arrival in the anaesthetic room, left ventricular ejection fraction 〈30%. The older group showed higher incidences of postoperative severe complication, operative mortality, and more grafts and longer time in intensive care unit （ICU）, and had lower incidents of valve disease and less use of left internal mammary artery [16 patients （13.6%） vs. 152 patients （49.4%）, all P〈0.05]. Conclusions The many CABG risk factors in China are different from those in the western countries. Although the higher incidents of postoperative severe complication and higher operative mortality are found in the older patients, the recovery period after operation isn＇t obviously prolonged. The operative outcomes are satisfactory.

关 键 词：冠状动脉分流术 非体外循环 危险因素 

分 类 号：R654.2[医药卫生—外科学]