高龄患者非体外循环下冠状动脉旁路移植术围术期的临床分析  

Perioperative clinical analysis of off-pump coronary artery bypass grafting in elderly patients

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

机构地区：[1]沈阳军区总医院心血管外科,110016

出　　处：《心肺血管病杂志》2015年第4期278-281,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的：比较75岁以上与65岁以下冠心病患者,非体外循环下冠状动脉旁路移植术（CABG）的围术期疗效。方法：回顾2013年12月至2014年7月,53例年龄75-85岁患者,及332例65岁以下于沈阳军区总医院心外科连续行限期CABG的患者。对比、分析上述两组患者的术前临床资料、手术时间、围术期并发症、住院时间及术后结果等围术期临床参数。结果：高龄患者术前合并二尖瓣或主动脉瓣轻度关闭不全、陈旧性肺部病变及缺血性脑部病变的比例明显高于低龄组;冠状动脉靶血管吻合时间、术中缩血管活性药物用量高龄组明显高于低龄组;术后心律失常、呼吸功能不全、胃肠功能紊乱、短期肾功能不全等并发症的发生率,高龄组明显高于低龄组;术后住院时间高龄组明显高于低龄组;两组围术期病死率无明显差异。结论：对于高龄患者,CABG疗效满意;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;术后心律失常及外周重要脏器功能紊乱为影响高龄患者术后恢复较为突出的因素,围术期应采取更为积极的观念和应对策略。Objective： Compare the effect of off-pump coronary artery bypass grafting between the patients older than 75 years and the patients under the age of 65. Methods： The datas of 53 patients at the age of75 - 85 and 332 patients under 65 years old who acceptted off-pump coronary artery bypass graft surgery from December 2013 to July 2014 in our hospital were reviewed. Compare and analyze the perioperative clinical parameters of the two groups. Results： In the preoperative datas,the proportions of mild mitral or aortic insufficiency,chronic lung disease,and ischemic brain lesions in elderly group were significantly higher than that in young group; In the intraoperative datas,anastomosis time of target vessels and dosage of vasoconstrictor drugs in the elderly group were significantly higher than that in young group; Incidence of the postoperative complications,such as arrhythmias,respiratory dysfunction,gastrointestinal dysfunction,and short-term renal insufficiency,was significantly higher in elderly group than that in young group; The hospitalization time after operation in elderly group was significantly higher than that in young group; No significant difference between the two groups in perioperative mortality. Conclusion： For elderly patients,the effect of off-pump coronary artery bypass grafting was satisfactory. However,the aged＇s heart was fragile to operation stimulation,and more careful anesthesia management should be done during operation. Arrhythmia and peripheral organ dysfunction occurred more easily in elderly patients,and more positive ideas and coping strategy should be taken.

关 键 词：冠状动脉疾病 冠状动脉旁路移植术 围术期 并发症 高龄 

分 类 号：R54[医药卫生—心血管疾病]