80岁及以上患者行不停跳冠脉搭桥手术的疗效探讨  

Study on the Curative Effect of Off-Pump Coronary Artery Bypass Surgery in Octogenarians

作　　者：刘乐 徐常力 张和平 孙振[1] 王士忠[1] 

机构地区：[1]青岛大学附属医院心外科,山东 青岛

出　　处：《临床医学进展》2021年第10期4720-4726,共7页Advances in Clinical Medicine

摘　　要：目的:讨论80岁及以上患者行冠脉不停跳搭桥的疗效。方法:回顾性分析青岛大学附属医院2014/01/01~2020/12/30入院并行不停跳搭桥高龄患者资料及随访1~7年的随访资料。结果:患者总数34例,年龄80~90岁,平均年龄82 (81, 82.5)岁,其中男性20例(58.8%),女性14例(41.2%),术后院内死亡3例(8.8%),放弃治疗出院2例(5.9%),急性脑梗1例(2.9%),气管切开3例(8.8%),二次插管2例(5.9%),CRRT置入3例(8.8%),IABP置入1例(2.9%),肺部感染9例(26.5%),胸腔积液11例(32.4%),术后胸骨松动1例(2.9%),患者随访1~7年,平均随访时间为3.5年,全因死亡5例(16.1%),因心衰死亡患者3例(9.7%),失联患者6例(19.4%),存活患者20例(64.5%),其中目前心功能III级3例(9.7%),心功能IV级4例(12.9%),房颤1例(3.2%),脑梗2例(6.5%),胸闷憋气再入院4例(12.9%)。结论:80岁及以上患者行不停跳冠脉搭桥手术疗效可,但因患者术前联合基础疾病较多,手术风险高,术后并发症多,术前需仔细评估,术后需家属细致看护,建议定期于医院复查。Objective: To discuss the curative effect of off-pump coronary artery bypass grafting surgery in octogenarians. Methods: In this retrospective analysis, clinical data were collected from 2014/01/01 to 2020/12/30, who had received off-pump coronary artery bypass grafting surgery in octogenarians in the department of cardiovascular surgery in Qingdao University Hospital and a follow-up data for 1 to 7 years after the surgery. Results: There were 34 patients in the study, the age of which is from 80 to 90 years old, with an average age of 82 (81, 82.5) years old. Among the patients, 20 were male patients (58.8%) and 14 were female patients (41.2%). During the perioperative period, there were 3 patients who died in hospital after operation (8.8%), and 2 of the patients gave up treatment and went home (5.9%). Perioperative complications included acute cerebral infarction in 1 patient (2.9%), tracheostomy in 3 patients (8.8%), secondary intubation in 2 patients (5.9%), CRRT in 3 patients (8.8%), and IABP in 1 patient (2.9%). 9 patients suffered from lung infection (26.5%), 11 patients suffered from pleural effusion (32.4%), 1 patient suffered from postoperative sterna looseness (2.9%). The patients in the study were followed up for 1 to 7 years, with an average follow-up time of 3.5 years. There were 5 deaths from all causes (16.1%), 3 deaths due to heart failure (9.7%). There are 6 patients (19.4%) disconnected now, and there are no check-up data or other data in the hospital after the surgery. There are still 20 surviving patients (64.5%), of which 3 patients are assessed as NYHA III (9.7%), 4 patients are assessed as NYHA IV (12.9%), 1 patient with atrial fibrillation (3.2%), 2 patients with cerebral infarction (6.5%), 4 patients with chest tightness and suffocation and re-admissions (12.9%). Conclusion: The curative effect of off-pump coronary artery bypass grafting surgery in octogenarians is good, but for the patients having many basic diseases before the operation, the surgical risk is high. There are many posto

关 键 词：非体外循环 冠脉搭桥术 死亡率 

分 类 号：R47[医药卫生—护理学]