75岁以上高龄患者非体外循环下冠脉旁路移植术的远期疗效  

Long-term outcomes of off-pump coronary artery bypass grafting in patients aged over 75years

作　　者：郭弈[1] 任崇雷[1] 高长青[1] 肖苍松[1] 张华军[1] 

机构地区：[1]解放军总医院心血管外科,北京100853

出　　处：《南方医科大学学报》2017年第1期75-78,共4页Journal of Southern Medical University

基　　金：国家"863"重大项目课题(2012AA021104);总后勤部保健专项课题(14BJZ19)~~

摘　　要：目的分析75岁以上高龄患者行非体外循环下冠脉旁路移植术(OPCAB)的远期疗效及其危险因素。方法 2000年11月~2013年11月,97例75岁以上高龄患者由同一术者完成非体外循环下冠脉旁路移植术。统计重症监护病房(ICU)时间、机械通气时间、术后并发症发生率及死亡率等围术期结果。出院后随访包括全因死亡及主要心脑血管不良(MACCE)事件(心肌梗死、脑血管事件、重复再血管化)。结果围术期死亡3例,在院死亡率3%,随访成功率93.81%,随访时间为(29-192)(95.61±34.07)个月。10年生存率为62%,10年MACCE事件免除率为47.4%。随访期间6例(6.8%)患者进行了重复再血管化,12例(12.37%)患者出现脑血管事件,5例(5.15%)出现心梗。Logistic回归分析显示术前合并高血压(OR=1.388,P=0.043)、糖尿病(OR=1.692,P=0.017)是高龄患者OPCAB术后远期MACCE事件的独立风险预测因素,而不完全再血管化并不会增加术后主要心脑血管不良事件(MACCE)事件发生率。结论高龄冠心病患者行非体外循环下冠脉旁路移植术是一种安全有效的手术方法,远期效果满意。高血压、糖尿病是高龄患者OPCAB术后发生MACCE事件的危险因素,但术后良好地控制血压及血糖可以有效降低MACCE事件的发生率,而不完全再血管化并不会对远期疗效产生不良影响。Objective To investigate the long-term outcomes of off-pump coronary artery bypass grafting （OPCAB） in patients aged over 75 years and analyze the risk factors affecting the outcomes of the procedure. Methods Clinical data were reviewed for 97 consecutive patients aged 75 years or above receiving OPCAB at our center between November, 2000 and November, 2013. The perioperative data including length of ICU stay, duration of mechanical ventilation, incidence of postoperative complications and mortality rate of the patients were analyzed. The follow-up data of the patients were also analyzed including all-cause mortality rate and major adverse cardiac and cerebral events （MACCE, including myocardial infarction, cerebrovascular event, and repeated revascularization）. Results The perioperative mortality rate was 3.09% （3/97） in these patients. Of the 97 patients analyzed, 91 （93%） were available for follow-up for 29-192 months （with a median of 95.61 ±34.07 months）. The 10-year survival rate of the patients was 62% with a 10-year MACCE-free survival rate of 47.4%. During the follow-up, 6 （6.8%） patients underwent repeated revascularization procedures, 12 （12.37%） had cerebrovascular accidents and 5 （5.15%） had myocardial infarction. Logistic regression analysis showed that hypertension （OR=1.388, P=0.043） and diabetes （OR=1.692, P=0.017） were independent predictors of MACCE, and incomplete revascularization did not increase the risk of postoperative MACCE. Conclusion OPCAB is safe and effective in elderly patients with good long-term outcomes. Hypertension and diabetes are independent risk factors of MACCE, and adequate control of blood pressure and blood glucose can reduce the incidence of postoperative MACCE. Incomplete revascularization is not detrimental to the long-term outcomes of OPCAB in elderly patients.

关 键 词：非体外循环下冠脉旁路移植术 高龄 远期疗效 

分 类 号：R654.2[医药卫生—外科学]