高龄患者非体外循环冠状动脉旁路移植围术期多因素分析  

Perioperative risk factors 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8期611-614,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的：分析制约高龄患者非体外循环冠状动脉旁路移植术后恢复的围术期危险因素。方法：回顾分析2013年8月至2014年4月,高龄非体外循环冠状动脉旁路移植患者53例,年龄75~86岁,均以左侧乳内动脉吻合左前降支;大隐静脉吻合其它分枝。所有患者均未使用序贯吻合。并行非体外循环冠状动脉旁路移植手术,手术在全麻下施行,所有患者均采用胸骨正中切口径路入胸,直视下获取左侧乳内动脉、大隐静脉。分析影响上述患者术后住院时间的危险因素。结果：心房颤动、胃肠功能紊乱、心血管意外、肾功能不全、再次机械辅助通气及脑血管意外为高龄患者术后主要并发症,以前二者最为常见。多因素Logistic回归分析显示女性、心功能Ⅲ-Ⅳ级、明显颈内动脉狭窄、慢性肾功不全、糖尿病及术中缩血管活性药物用量等,术前及术中因素为影响术后住院时间的独立危险因素;在术后并发症中,除肾功能不全,其余并发症为影响术后住院时间的独立危险因素。结论：术前多种合并症影响患者术后住院时间;术中过量血管活性药物应用提示心脏耐受力不佳,并影响术后住院时间。术后并发症,以心房颤动、胃肠功能紊乱最为常见且明显延长术后住院时间;再次机械辅助通气、脑血管意外、心血管意外发生率不高,但明显影响术后住院时间。Objectivc：Analysize the perioperative risk factors influencing recovery of elderly patients with off-pump coronary artery bypass graft. Methods： 53 patients at the age of 75 - 86 who aeeeptted off-pump coronary artery bypass graft surgery from August 2013 to April 2014 in our hospital were reviewed. The perioperative risk factors influencing postoperative hospital stay were analysized. Results： Atrial fibrillation, gastrointestinal disorders, cardiovascular accident, renal dysfunction, repeated mechanical ventilation and cerebral vascular accident were main complications, and the first two were the most common. Multivariate logistic regression analysis showed that several preoperative and intraoperative factors including female, heart NYHA class, internal carotid artery stenosis, chronic renal failure, diabetes mellitus, intraoperative dosage of constrictive vasoaetive drug were the independent risk factors prolonging postoperative hospital stay; all the postoperative complications except renal dysfunction were the independent risk factors. Conclusion： Multiple preoperative comorbidi- ties influenced elderly patients＇ recovery. Excessive application of constrictive vasoaetive drug meaned heart was fragile to operation stimulation, and indicated a prolonged hospital stay. Atrial fibrillation and gastrointestinal dysfunction were the most common complications ,which both prolonged postoperative hospital stay. The occurrence rate of repeated mechanical ventilation, cerebral vascular accident, and cardiovascular accident was not high, but significantly prolonged the postoperative hospital stay.

关 键 词：高龄 冠状动脉旁路移植术 围术期 冠心病 并发症 

分 类 号：R54[医药卫生—心血管疾病]