80岁以上高龄患者行冠状动脉旁路移植术临床疗效分析  

Clinical efficacy of coronary artery bypass grafting in aged patients over 80

作　　者：肖志斌[1] 张永[1] 李大连[1] 姚建民[2] 郭建中[1] 程志广[1] 崔永超[1] 李莹莹[1] 

机构地区：[1]首都医科大学附属北京友谊医院心血管中心心脏外科,北京100065 [2]北京军区总医院心血管外科

出　　处：《中国循证心血管医学杂志》2014年第6期724-726,732,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的观察80岁以上患者行冠状动脉旁路移植术(CABG)的临床效果。方法选择2001年10月至2013年10月,在北京军区总医院心血管外科行CABG手术年龄>80岁的高龄冠心病患者60例,其中男性53例,女性7例,平均年龄(82.65±2.27)岁。急诊手术5例。体外循环下搭桥(on-pump)6例,非体外循环下搭桥(off-pump)54例。记录患者冠状动脉搭桥数量,围手术期呼吸机辅助呼吸时间、住院时间、重要脏器并发症发生率以及近期心肌缺血事件发生率。结果纳入患者平均搭桥(3.13±0.24)支,术后呼吸机辅助呼吸(10.11±4.37)h,平均住院时间(11.36±4.51)d。围手术期死亡率为5%。并发症发生率依次为胸腔积液(48.3%)、低氧及高碳酸血症(30.0%)、心房颤动(26.7%)、肾功能不全(23.3%)、低心排综合征(5.0%)等。患者出院后随访3个月,均无心肌缺血事件发生。结论做好充分的术前准备、评估及围手术期管理,80岁以上高龄患者的CABG手术依然可以取得良好效果。Objective To observe the clinical efficacy of coronary artery bypass grafting （CABG） in aged patients over 80 with coronary heart disease （CHD）.Methods The patients （n=60, male 53 and female 7, average age=82.65±2.27） with CABG were chosen from Oct. 2001 to Oct. 2013. Among them, there were 5 with emergency CABG, 6 with on-pump CABG, and 54 with off-pump CABG. The number of coronary bypass, respirator supporting time during perioperative period, hospitalization time, incidence of vital organs complications and short-term incidences of myocardial ischemia events were recorded.Results The average number of bypass was （3.13± 0.24）, respirator supporting time after CABG was （10.11±4.37） h, average hospitalization time was （11.36±4.51） d. The perioperative mortality was 5%, and incidences of complications were, in a descending order, pleural effusion （48.3%）, hyoxemia and hypercapnia （30.0%）, atrial fibrillation （26.7%）, renal insufficiency （23.3%） and low cardiac output syndrome （5.0%）. All patients were followed up for 3 m after discharged from hospital and there were no myocardial ischemia events found.Conclusion With sufficient preoperative preparation, review and management, CABG will get good results in aged patients over 80.

关 键 词：冠状动脉旁路移植术 高龄老年 冠心病 

分 类 号：R654.2[医药卫生—外科学]