高龄冠心病患者接受非体外循环冠状动脉旁路移植不完全血运重建对围手术期风险的影响  

Impacts of incomplete revascularization following off-pump coronary artery bypass grafting on perioperative outcomes in octogenarians

作　　者：彭战 华琨[1] 张良 毛斌[1] 周元[1] 张晋伟[1] 杨秀滨 Peng Zhan;Hua Kun;Zhang Liang;Mao Bin;Zhou Yuan;Zhang Jinwei;Yang Xiubin(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Vessel Disease,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,北京100029

出　　处：《中华医学杂志》2020年第40期3152-3156,共5页National Medical Journal of China

基　　金：北京市医院管理中心青苗计划专项(QML20170605);北京市优秀人才培养资助青年骨干个人项目(2017000021469G225);北京市教委一般项目(KM201910025013)。

摘　　要：目的探讨80岁以上高龄冠心病患者接受非体外循环冠状动脉旁路移植(OPCABG)不完全血运重建对围手术期风险的影响。方法纳入首都医科大学附属北京安贞医院2008年6月至2016年7月242例80岁以上接受单纯OPCABG手术治疗的冠心病患者的院内围手术期资料,根据其是否进行完全血运重建分为完全血运重建组(n=181)和不完全血运重建组(n=61),分析高龄患者接受OPCABG不完全血运重建后的围手术期临床结局。结果242例接受OPCABG的80岁以上患者中,男198例(81.8%)。与完全血运重建组比较,不完全血运重建组年龄较大[(83.2±1.5)岁比(81.5±1.1)岁,P=0.03],颈动脉狭窄比例较高(44.3%比25.4%,P=0.01),冠状动脉病变中累及对角支(49.2%比17.1%,P=0.01)和回旋支(83.6%比70.2%,P=0.03)的比例较高,手术时间较短[(4.1±1.7)h比(4.7±1.2)h,P=0.03],术前住院时间较长[(7.1±2.3)d比(5.2±2.0)d,P=0.01],总住院天数较长[(16.3±6.8)d比(12.5±4.2)d,P=0.01],两组患者院内死亡率和其他围手术期并发症发生率的差异无统计学意义(均P>0.05)。结论相比于完全血运重建的OPCABG,80岁以上高龄冠心病患者接受OPCABG不完全血运重建后并不增加围手术期死亡率及其他并发症发生率,手术时间减少,但术前和总住院时间较长。Objective To assess the impacts of incomplete revascularization following off-pump coronary artery bypass grafting(OPCABG)on perioperative outcomes in octogenarians.Methods A retrospective analysis of 242 octogenarian patients with coronary artery disease(CAD)hospitalized in Beijing Anzhen Hospital from June 2008 to July 2016 was performed.These patients were divided into the complete revascularization group(n=181)and the incomplete revascularization group(n=61)depending on whether they underwent complete revascularization.The impacts of incomplete revascularization following OPCABG on perioperative outcomes were summarized and compared between the two groups.Results Among the 242 patients over 80 years who received OPCABG,there were 198 males(81.8%).Compared to the complete revascularization group,those in the incomplete revascularization group were older[(83.2±1.5)vs(81.5±1.1)years old,P=0.03],with more carotid stenosis(44.3%vs 25.4%,P=0.01),more involved in the diagonal and circumflex branch of coronary artery(49.2%vs 17.1%,P=0.01;83.6%vs 70.2%,P=0.03),shorter operative time[(4.1±1.7)h vs(4.7±1.2)h,P=0.03],longer preoperative[(7.1±2.3)d vs(5.2±2.0)d,P=0.01]and total hospitalization time[(16.3±6.8)d vs(12.5±4.2)d,P=0.01],however,the differences of the in-hospital mortality and incidence of other perioperative complications were not statistically significant between the two groups(all P>0.05).Conclusion Compared with complete revascularization,incomplete revascularization following OPCABG in CAD patients over 80 years old does not increase the perioperative mortality and the incidence of other complications,and it reduces the operative time.However,it increases the time of preoperative and total hospital stay.

关 键 词：冠状动脉旁路移植术 非体外循环 老年人 80以上 不完全血运重建 

分 类 号：R654.3[医药卫生—外科学]