高龄冠心病患者行冠状动脉旁路移植术的临床分析  

Clinical analysis on octogenarians undergoing coronary artery bypass grafting

作　　者：罗文琦[1] 欧阳小康[1] 甄文俊[1] 王怀斌[1] 谭洁[1] 马玉健[1] 王子[1] 

机构地区：[1]北京医院心血管外科,100730

出　　处：《中国心血管杂志》2015年第2期132-135,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的 对接受冠状动脉旁路移植术（CABG）的高龄冠心病患者的临床特点进行分析,评价其手术方式和治疗效果。方法 回顾性分析我院2012年6月至2014年5月接受CABG的19例高龄冠心病患者的临床特点,其中男性15例,女性4例,年龄80~91岁,平均（82.7±3.3）岁,体外循环下CABG 14例,非体外循环下CABG 3例,体外循环辅助心脏不停跳2例。旁路移植血管数（3.2±1.1）支。结果 接受CABG的高龄患者合并疾病多,15例为不稳定型心绞痛,16例有心肌梗死病史。本组患者围术期死亡1例。术后有52.6%的患者发生心房颤动,另外急性肾损伤（31.6%）、心功能不全（42.1%）、慢性贫血（42.1%）、低蛋白血症（47.4%）等发生率也较高。结论 高龄患者合并疾病多、病情危重,术前需细致评估,围术期尤其需精细管理,出院后适当增加随诊频率。Objective To investigate the clinical characteristics, evaluate the operative procedure and clinical results of octogenarians underwent coronary artery bypass grafting （ CABG）. Methods The retrospective analysis included the medical data on 19 patients aged 80 years or greater undergoing CABG at our department of cardiac surgery from June 2012 to May 2014. There were 15 male and 4 female patients, aging from 80 to 91 years with a mean of （82. 7 ± 3. 3） years. Fourteen patients underwent cardiopulmonary bypass or on - pump CABG, three patients underwent off - pump CABG and two patients underwent beating heart CABG assisted with extracorporeal circulation. The number of bypass grafts was 1 to 4 （mean 3. 2 ± 1. 1）. Results There were more coexisting diseases in octogenarians underwent CABG. Fifteen patients were unstable angina pectoris and sixteen patients had a history of myocardial infarction. One patient died in postoperative period. The most frequent complication was atrial fibrillation （52. 6% ）. Acute kidney injury （AKI） （ 31. 6% ）, cardiac insufficiency （ 42. 1% ）, chornic anemia （ 42. 1% ） and hypoproteinemia （47. 4% ） were observed at a higher incidence. Conclusions Because of critical preoperative state and with more comorbidity, careful preoperative evaluation and intensive perioperative treatment must be enhanced in octogenarians who underwent CABG. Frequency of postoperative follow - up can be properly increased.

关 键 词：老年人 80岁以上 冠状动脉疾病 冠状动脉旁路移植术 临床分析 

分 类 号：R654.2[医药卫生—外科学]