老年糖尿病患者非体外循环冠状动脉旁路移植术后临床分析  

Clinical analysis of off-pump coronary artery bypass grafting in elderly patients with diabetes mellitus

作　　者：郝懿[1] 杨海平[1] 陈林[1] 张振华[1] Hao Yi;Yang Haiping;Chen Lin;Zhang Zhenhua(Department of Cardiac Surgery,Beijing Luhe Hospital of Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京潞河医院心脏外科,101149

出　　处：《中华老年医学杂志》2019年第9期985-988,共4页Chinese Journal of Geriatrics

摘　　要：目的对老年糖尿病患者非体外循环冠状动脉(冠脉)旁路移植术后情况进行临床分析。方法回顾性分析2012年1月至2018年6月糖尿病和非糖尿病老年患者非体外循环冠脉旁路移植术115例围术期临床资料,比较糖尿病对老年患者非体外循环冠脉旁路移植术后的影响。结果与非糖尿病患者比较,老年糖尿病患者非体外循环冠脉旁路移植术后肺部感染、围术期心肌梗死、神经系统并发症、精神症状、低心排综合征、术后30 d死亡、输血量、二次开胸、呼吸衰竭、心律失常发生率、呼吸机辅助呼吸时间、术后24 h引流量、术后住院天数、术后大剂量多巴胺使用例数(>10μg·kg^-1·min^-1)略高于非糖尿病组患者,但差异均无统计学意义(均P>0.05);而术后肾功能不全、切口并发症较非糖尿病老年患者有所增加,差异有统计学意义(χ^2=3.736、1.237,P=0.021、0.037)。结论老年糖尿病患者在科学控制血糖的情况下,采用非体外循环冠状旁路移植术是安全有效的。Objective To conduct a clinical analysis of off-pump coronary artery bypass grafting(CABG)in elderly patients with diabetes mellitus.Methods Clinical data of 115 elderly patients with or without diabetes mellitus undergone off-pump CABG from January 2012 to June 2018 were retrospectively analyzed.The impact of diabetes mellitus on the prognosis in elderly patients undergone off-pump CABG was analyzed.Results Compared with elderly non-diabetic patients,the incidences of pulmonary infection,perioperative myocardial infarction,neurological complications,psychiatric symptoms,low cardiac output syndrome,rethoracotomy,respiratory failure,arrhythmia,postoperative 30-day mortality,blood transfusion volume,mechanical ventilation time,postoperative 24-hour drainage volume,the length of hospital stay and large doses of dopamine usage(>10μg·kg^-1·min^-1)increased lightly in elderly diabetic patients after off-pump CABG,but the difference had no statistical significance(all P>0.05).The incidences of postoperative renal insufficiency and incision complications were higher in elderly diabetic patients than in elderly non-diabetic patients(χ^2=3.736、1.237,P=0.021、0.037).Conclusions Off-pump CABG is safe and effective for elderly diabetic patients if their blood glucose levels are controlled reasonably well.

关 键 词：冠心病 糖尿病 冠状动脉旁路移植术 非体外循环 

分 类 号：R654.2[医药卫生—外科学]