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80岁以上患者行冠状动脉旁路移植术的临床研究

付强1,梁德刚1,阮昕华2,李全正2,贾立群1,魏民新1   

  1. 1. 天津医科大学总医院
    2. 天津医科大学总医院心血管外科
  • 收稿日期:2011-04-21 修回日期:2011-06-15 出版日期:2011-09-15 发布日期:2011-09-15
  • 通讯作者: 付强

Coronary Artery Bypass Surgery in Octogenarians

  • Received:2011-04-21 Revised:2011-06-15 Published:2011-09-15 Online:2011-09-15

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摘要： 摘要 目的： 探讨80岁以上高龄病人行冠状动脉旁路移植术的临床经验。方法： 自2008年2月至2011年1月，我院共为37例80岁以上高龄病人行冠状动脉旁路移植术,其中男性30例，女性7例，年龄80-91岁，平均83.11±2.90岁。行不停跳冠状动脉旁路移植术 31例（83.8%），体外循环冠状动脉旁路移植术1例（2.7%）；体外循环冠状动脉旁路移植术+二尖瓣置换3例（8.1%），体外循环冠状动脉旁路移植术+主动脉瓣置换2例（5.4%）。 结果： 平均移植3.0±0.79支血管桥，术后死亡1例，死亡率为2.7%。术后发生主要并发症包括：房颤18例，呼吸功能不全致脱机困难8例（1例行气管切开），低心排综合征6例，急性肾功能损伤2例（2例行持续性肾脏替代治疗），脑部并发症1例，纵隔出血及心包填塞二次开胸1例。围手术期应用主动脉内球囊反搏7例（18.9%）。平均ICU滞留天数为3.35±1.99天，平均术后住院天数为13.03±4.39天。37例病人随访3-39个月（平均22.47±11.15月），随访期死亡1例。结论： 80岁以上高龄患者冠状动脉旁路移植术可行，通过注重术前评估，改进手术技术，加强围手术期的观察和处理，能够进一步提高手术安全性。

关键词: 80岁老人, 冠状动脉旁路移植术, 围手术期治疗

Abstract: Abstract Objective: To investigate the peri-operative treatments of coronary artery bypass grafting in octogenarians. Methods: From January 2008 to March 2011, 37 patients(30 male,7 female) 80 years of age or older(80-91years,mean 83.11±2.90 years) underwent coronary artery bypass grafting. 31 patients underwent off pump coronary artery bypass grafting (83.8%) and 1 patients underwent conventional on pump coronary artery bypass grafting (2.7%) and 3 patients underwent simultaneous mitral valve replacement and coronary artery bypass grafting (8.1%) and 2 patients underwent simultaneous aortic valve replacement and coronary artery bypass grafting (5.4%). Results: One patients died post-operatively. The mortality was 2.7%. Major postoperative complications included atrail fibrillation in 18 cases, respiratory dysfunction in 8 cases( 1 patients underwent trachyotomy), low cardiac output in 6 cases,acute kidney injury in 2 cases(2 patients underwent continuous renal replacement treatment) and stroke in one case. Hemorrhage or tamponade requiring reoperation in 1 cases. Intra-aortic balloon pump was used in 7 patients (18.9%). The average ICU stay was 3.35±1.99 days. Mean postoperative in-hospital stay was 13.03±4.39 days. Thirty-seven patients were followed up from 3-39 months. One patient died during the follow-up period. Conclusions: Coronary artery bypass grafting in octogenarians is safe. Intensive perioperative treatment should be stressed in octogenarians to reduce the morbidity and mortality.

Key words: Octogenarian, Coronary artery bypass grafting, peri-operative treatment