摘要
目的探讨高龄患者非选择性病例行单纯非体外循环冠状动脉旁路移植术(off-pump coronary artery bypassgrafting,OPCABG)的安全性和可行性。方法 2008年5月～2011年5月248例50岁以上冠状动脉硬化性心脏病(冠心病)术前均拟定行OPCABG,全身麻醉,正中开胸,取自身乳内动脉、桡动脉、大隐静脉等,心脏不停跳下对病变冠状动脉进行血管重建。根据患者年龄分为2组:年龄50～70岁为A组(n=164),年龄≥70岁B组(n=84),观察指标包括死亡率、并发症、术后输血量、呼吸机辅助时间、移植血管、主动脉内球囊反搏的使用等。结果 A组术后输血量显著少于B组[0 ml(0～6400ml)vs.800 ml(0～2800 ml),Z=-4.606,P=0.000],呼吸机辅助时间显著短于B组[11 h(3～118 h)vs.14 h(5～189 h),Z=-3.093,P=0.002],乳内动脉使用率显著低于B组[60.4%(99/164)vs.90.5%(76/84),χ2=22.246,P=0.000],桡动脉使用率显著高于B组[60.4%(99/164)vs.11.9%(10/84),χ2=52.957,P=0.000],使用内镜血管取材率显著低于B组[56.7%(93/164)vs.72.6%(60/84),χ2=5.094,P=0.024],主动脉内球囊反搏使用率显著低于B组[5.5%(9/164)vs.13.1%(11/84),χ2=4.336,P=0.037],余各指标差异均无显著性(P>0.05)。结论 OPCABG对高龄患者是安全可行的。
Objective To investigate the efficacy, safety and feasibility of isolated off-pump coronary artery bypass grafting （OPCABG） for unselected elderly patients. Methods From May 2008 to May 2011, we performed OPCABG on 248 patients with coronary heart disease, who were older than 50 years. Under general anesthesia, we open the chest in middle, and reconstructed the coronary artery with the internal mammary artery, radial artery, or great saphenous vein. The patients were divided into groups A and B based on their age （ group A ： 50 - 70 years, n = 164 ; group B ： ≥ 70 years, n = 84）. The rates of death and complications, volume of blood transfusion, time of mechanical ventilation, the grafted artery, and the use of intra-aortie balloon counterpulsation （IABC） were compared between the two groups. Results Compared to group B, group A had significantly less blood transfusion [0 ml （0 - 6400 ml） vs. 800 ml （0-2800 ml）, Z= -4.606, P=0. O00], shorter mechanical ventilation [11 h （3-118 h） vs. 14 h （5- 189 h）, Z = - 3. 093, P = 0. 002 ], less use of the internal mammary artery [ 60.4% （99/164） vs. 90.5% （76/84）, Xz = 22. 246, P =0.000], more use of the radical artery [60.4% （99/164） vs. 11.9% （10/84）, X2 = 52. 957, P = 0. 000], lower rate of endoscopic vessel harvesting [56.7% （93/164） vs. 72.6% （60/84）, X2 = 5. 094, P = 0. 024], and less use of IABC [5.5% （9/164） vs. 13. 1% （11/84）, X2 =4. 336, P = 0. 037 ]. No significant difference was detected in the other items between the two groups. Conclusion OPCABG is safe and feasible for elderly patients.
出处
《中国微创外科杂志》
CSCD
2012年第8期678-681,共4页
Chinese Journal of Minimally Invasive Surgery
