摘要
目的探讨80岁以上高龄冠心病患者行非体外循环冠状动脉旁路移植术(OPCABG)的安全性和临床效果。方法 2012年1月至2015年1月,我院共有30例80岁以上高龄冠心病患者接受OPCABG,包括胸腔镜辅助下微创冠状动脉旁路移植术5例。其中男性24例,女性6例,年龄80~86岁,平均年龄83.5岁。所有高龄患者术前均行呼吸功能锻炼,时间1~4周。同期80岁以下冠心病患者接受OPCABG 260例。比较不同年龄组的移植血管数目、机械通气时间、术后并发症、监护室时间、死亡率等,总结高龄冠心病患者行OPCABG的安全性和临床效果等。结果 80岁以上高龄冠心病患者组围手术期死亡1例,其余29例症状明显改善,顺利出院。80岁以上高龄冠心病患者组术后神经系统并发症例数为12例,发生率为40%,较80岁以下冠心病患者组神经系统并发症发生率(4.6%)高(P=0.02),术后拔除气管插管时间为(10.5±5.5)h,较80岁以下组[(6.5±4.5)h]时间长(P<0.001),术后平均住院时间为(15.0±5.5)d,较80岁以下组[(11.0±3.5)d]住院时间长(P=0.03)。80岁以上高龄冠心病患者组和80岁以下冠心病患者组平均再血管化数目分别为(3.0±0.6)支、(3.1±1.5)支,低心排出量分别为1例(3.3%)、8例(3.1%),呼吸系统并发症分别为9例(30%)、32例(12.3%),术后肾功能不全分别为4例(13.3%)、12例(4.6%),心律失常分别为16例(53.3%)、155例(59.6%),术后30 d死亡分别为1例(3.3%)、5例(1.9%),两组比较差异均无统计学意义(P>0.05)。结论 80岁以上高龄冠心病患者行OPCABG,再血管化数目不受影响,近期临床效果较好,其并发症及死亡率较低。但术前需经过充分的评估和术前准备,尤其是呼吸功能锻炼。高龄患者行OPCABG安全有效。
Objective To investigate the surgical technique safety and clinical results of off-pump coronary artery bypass grafting(OPCABG) on patients over eighty years old. Methods From January 2012 to January 2015, 30 patients over eighty years old underwent OPCABG(include minimally invasive direct CABG), 24 patients were male and 6 patients were female. The age of patients ranged from 80 to 86 years old with average age of 83.5 years old. All patients underwent respiratory function exercise for 1 to 4 weeks. 260 patients under eighty years old underwent OPCABG in the same period. The grafts number, mechanical ventilation time, complications and mortality rate between different groups were compared. Results One died in hospital, the left 29 patients were discharged from the hospital successfully in patients over eighty years old cases. The incidence of nervous system complication on patients over eighty years old(40%) was higher than under eighty years old(4.6%, P=0.02). There were statistical differences on mechanical ventilation time [(10.5±5.5)h vs.(6.5±4.5)h] and hospitalization time [(15.0±5.5)d vs.(11.0±3.5)d] between the two groups(P<0.001, P=0.03). There were no significant statistical differences in grafts number(3.0±0.6 vs. 3.1±1.5), low cardiac output(3.3% vs. 3.1%), the respiratory system complications(30% vs. 12.3%), renal dysfunction(13.3% vs. 4.6%), arrhythmia(53.3% vs. 59.6%) and mortality rate(3.3% vs. 1.9%) between the two groups(P>0.05). Conclusion The early metaphase clinical result of OPCABG on patients over eighty years old is good, there are fewer complications and low mortality rate. Preoperative preparation is important especially in the respiratory function exercise. OPCABG on patients over eighty years old is safe and effective.
出处
《中华临床医师杂志（电子版）》
CAS
2016年第17期2535-2538,共4页
Chinese Journal of Clinicians(Electronic Edition)
