老年患者行冠状动脉旁路移植术的临床研究(1)
[摘要] 目的 探讨老年(70岁以上)冠心病患者冠状动脉旁路移植术(CABG)的术式选择、临床疗效和围术期处理。方法 选择2005年1月～2013年12月间58例≥70岁接受冠状动脉旁路移植术的患者，分为非体外循环冠状动脉旁路移植术组(OPCAB)36例和体外循环下冠状动脉旁路移植术组(ONCAB)22例，比较两组临床疗效、术后死亡率及并发症的发生情况。 结果 OPCAB组和ONCAB组的手术时间为(178.47±28.72)min和(257.35±30.53)min、呼吸机辅助时间(10.10±7.32)h和(16.24±7.25)h、术后住院时间(8.3±2.5)d和(12.6±3.5)d，差异有统计学意义(P<0.05)，但两组在术后死亡、脑卒中等并发症方面无统计学意义(P>0.05)。 结论 CABG术式的选择不影响高龄冠心病患者的预后，手术方案的个性化制定和围术期的密切监护，是确保手术疗效的关键。
[关键词] 冠状动脉旁路移植术；体外循环；非体外循环；老年；预后
[中图分类号] R654.3 [文献标识码] B [文章编号] 2095-0616(2015)08-150-04
Clinical research of the coronary artery bypass graft for elderly patient
WANG Jian LI Shuzhen ZHAO Long GUO Junxiao ZHANG Yulong GAO Rong LIU Zhiping ZHU Xianming
Department of Cardiovascular Surgery，the Affiliated Hospital of Inner Mongolia Medical University，Hohhot 010050，China
[Abstract] Objective To explore the selection of operation，clinical efficacy and perioperative treatment of coronary artery bypass graft for elderly patients (above 70 years old). Methods 58 patients，who were above70 years and given coronary artery bypass grafting from 2005 January to 2013 December，were selected and divided into the off-pump coronary artery bypass grafting group (OPCAB group) in 36 cases and on-pump coronary artery bypass grafting group (ONCAB) in 22 cases.The clinical curative effect，the postoperative mortality and complications of two groups were compared. Results The operation time (178.47+28.72)min，the time of mechanical ventilation (10.10±7.32) hours，hospitalization time and postoperative (8.3±2.5) days of OPCAB group were significantly shorter then those of the ONCAB group (257.35±30.53) minutes，(16.24±7.25)hours，and(12.6±3.5)days， (P<0.05)，but the incidence of the postoperative death，stroke and other complications of two groups had no statistical significance (P>0.05). Conclusion The choice of CABG operative method did not affect the prognosis of elderly patients with coronary heart disease.The operation scheme formulation of operation scheme and close perioperative monitoring are the keys to ensure the efficacy of operation.
[Key words] Coronary arterybypass grafting；On-pump；Off-pump；The elderly；Prognosis
冠状动脉旁路移植手术(CABG)是外科治疗冠心病的主要手段，目前已是一种稳定而成熟有效的技术，近年来在全国逐渐推广，主要适用于对内科治疗(药物、PCI)无效的冠心病患者，对高龄、多支病变、陈旧心肌梗死、心功能较差的患者仍具有良好的安全性，而对于并发室壁瘤、室间隔穿孔、瓣膜病变的患者则是唯一的选择。随着心脏外科手术技术及器械的不断提高及发展，老年冠心病患者接受冠状动脉旁路移植术的比例逐年增多，然而年龄仍然是影响手术疗效的重要因素之一[1-3]。老年
患者多合并高血压、糖尿病、肾功能不全等并发症，围术期死亡率和并发症发生率相对较高。现总结我科收治的年龄≥70岁行冠状动脉旁路移植术的患者58例，旨在探讨老年冠心病患者冠状动脉旁路移植术的术式选择、临床疗效和围术期处理特点。, http://www.100md.com(王坚?李淑珍等)
[关键词] 冠状动脉旁路移植术；体外循环；非体外循环；老年；预后
[中图分类号] R654.3 [文献标识码] B [文章编号] 2095-0616(2015)08-150-04
Clinical research of the coronary artery bypass graft for elderly patient
WANG Jian LI Shuzhen ZHAO Long GUO Junxiao ZHANG Yulong GAO Rong LIU Zhiping ZHU Xianming
Department of Cardiovascular Surgery，the Affiliated Hospital of Inner Mongolia Medical University，Hohhot 010050，China
[Abstract] Objective To explore the selection of operation，clinical efficacy and perioperative treatment of coronary artery bypass graft for elderly patients (above 70 years old). Methods 58 patients，who were above70 years and given coronary artery bypass grafting from 2005 January to 2013 December，were selected and divided into the off-pump coronary artery bypass grafting group (OPCAB group) in 36 cases and on-pump coronary artery bypass grafting group (ONCAB) in 22 cases.The clinical curative effect，the postoperative mortality and complications of two groups were compared. Results The operation time (178.47+28.72)min，the time of mechanical ventilation (10.10±7.32) hours，hospitalization time and postoperative (8.3±2.5) days of OPCAB group were significantly shorter then those of the ONCAB group (257.35±30.53) minutes，(16.24±7.25)hours，and(12.6±3.5)days， (P<0.05)，but the incidence of the postoperative death，stroke and other complications of two groups had no statistical significance (P>0.05). Conclusion The choice of CABG operative method did not affect the prognosis of elderly patients with coronary heart disease.The operation scheme formulation of operation scheme and close perioperative monitoring are the keys to ensure the efficacy of operation.
[Key words] Coronary arterybypass grafting；On-pump；Off-pump；The elderly；Prognosis
冠状动脉旁路移植手术(CABG)是外科治疗冠心病的主要手段，目前已是一种稳定而成熟有效的技术，近年来在全国逐渐推广，主要适用于对内科治疗(药物、PCI)无效的冠心病患者，对高龄、多支病变、陈旧心肌梗死、心功能较差的患者仍具有良好的安全性，而对于并发室壁瘤、室间隔穿孔、瓣膜病变的患者则是唯一的选择。随着心脏外科手术技术及器械的不断提高及发展，老年冠心病患者接受冠状动脉旁路移植术的比例逐年增多，然而年龄仍然是影响手术疗效的重要因素之一[1-3]。老年
患者多合并高血压、糖尿病、肾功能不全等并发症，围术期死亡率和并发症发生率相对较高。现总结我科收治的年龄≥70岁行冠状动脉旁路移植术的患者58例，旨在探讨老年冠心病患者冠状动脉旁路移植术的术式选择、临床疗效和围术期处理特点。, http://www.100md.com(王坚?李淑珍等)