高龄对非体外循环冠状动脉旁路移植围术期疗效的影响  

Impact of advanced age on peri- operative effect of off- pump coronary artery bypass grafting

作　　者：张仁腾[1] 姜辉[1] 王辉山[1] 周南[1] 杨忠路[1] 高昊[1] 

机构地区：[1]沈阳军区总医院心血管外科,沈阳110016

出　　处：《中国体外循环杂志》2015年第1期40-44,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的分析高龄对非体外循环冠状动脉旁路移植围术期疗效的影响。方法回顾2013年8月至2014年4月非体外循环冠状动脉旁路移植术患者638例,其中75～86岁（高龄组）53例,65岁以下（低龄组）585例。对比、分析上述两组患者的围术期临床数据。结果 1术中冠状动脉靶血管吻合时间、缩血管活性药物用量高龄组明显高于低龄组;术后气管插管时间、住院时间及再次机械辅助通气、心房颤动、胃肠功能紊乱、短期肾功能不全等并发症高龄组明显高于低龄组;两组围术期脑血管意外、心血管意外及死亡率无明显差异。2多因素Logistic回归分析显示高龄是影响靶血管吻合时间、术中缩血管活性药物用量、气管插管时间、住院时间以及术后再次机械辅助通气、心房颤动、胃肠功能紊乱等并发症的独立风险因素。3并发症为导致高龄患者术后住院时间延长的独立风险因素。结论高龄患者非体外循环冠状动脉旁路移植术疗效满意,术后心脑血管意外、患者死亡率在高龄组并未明显增加;但高龄患者心脏耐受手术刺激的能力差,术中对麻醉要求高;术后心房颤动、呼吸功能不全及胃肠功能紊乱等并发症更易发生于高龄患者,是导致高龄患者术后住院时间延长的重要原因,围术期应采取更为积极的观念和应对策略。Objective To analyze the impact of advanced age on peri-operative curative effect of off-pump coronary artery bypass grafting. Methods 53 patients at the age of 75-86（ elderly group） and 585 patients under 65 years old（ youg group） who continuously accept off-pump coronary artery bypass graft surgery from August 2013 to April 2014 in our hospital were reviewed. The peri-operative clinical parameters of the two groups were compared and analyzed. Results 1. In the intraoperative data,such as anastomosis time of target coronary artery and dosage of the vasoconstrictor drugs,the elderly group was significantly higher than young group.In incidence of the post-operative complications,such as arrhythmias,respiratory dysfunction,gastrointestinal dysfunction,and shortterm renal insufficiency,the elderly group was significantly higher than the young group. No significant difference between the two groups in cerebral vascular accident,ardiac vascular accident and peri-operative mortality. 2. Multivariate logistic regression analysis revealed the independent risk factors for target vessel anastomosis time,intraoperative vasoconstrictor drug dosage,time of tracheal cannula and post-operative complications such as repeated mechanical ventilation,atrial fibrillation and gastrointestinal dysfunction. 3.The above complications were all independent risk factors of prolonged post-operative hospitalization of elderly patients. Conclusion For elderly patients,the effect of off-pump coronary artery bypass grafting was satisfactory. Cardiovascular accident,cerebral vascular accident and mortality did not increase in the elderly group. However,the ability to tolerate operation stimulation was poor in the elderly patients,and careful anesthetic management was necessary. Post-operative arrhythmia,respiratory insufficiency and gastrointestinal dysfunction were more likely to occur in the elderly patients,which prolonged post-operative hospitalization of elderly patients,and more positive ideas and coping strategy should be taken.

关 键 词：高龄 冠心病 冠状动脉旁路移植 围术期 并发症 

分 类 号：R654.2[医药卫生—外科学]