Perioperative Efcacy on Coronary Artery Bypass Grafing in Elderly Patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 张仁腾 , 姜辉 , 葛玉光 , 孟庆涛 , 高昊 , 唐传乙

沈阳军区总医院心血管外科（沈阳 110016）;

Corresponding author：

张仁腾, Email: zhangrenteng@163.com

Keywords：

高龄患者; 冠心病; 冠状动脉旁路移植; 围手术期; 并发症

DOI：

10.7507/1007-4848.20150130

Video：

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目的总结75岁以上高龄冠心病患者行冠状动脉旁路移植术（CABG）的围手术期临床经验，以提高手术疗效。方法 2014年2～6月沈阳军区总医院心外科为20例75～84岁冠状动脉粥样硬化患者行非体外循环冠状动脉旁路移植术，其中男11例、女9例，主要病变均为三支冠状动脉严重狭窄或伴左主干狭窄，其中5例患者伴急性心肌梗死，所有患者均为限期手术。分析全组手术时间、住院时间、围手术期并发症、术后结果等。结果全组均采用左乳内动脉吻合前降支，大隐静脉吻合其他分支，平均桥血管数量为3.2支；平均手术时间3.3 h；术后平均呼吸机辅助时间9.6 h；术后平均重症监护时间26.4 h；术后平均住院时间为12.3 d。术后出现阵发性心房颤动3例；术后呼吸机辅助期间低氧血症2例，术后因咳痰无力及误吸并发严重肺炎1例；术后明显腹胀、纳差6例，其中1例因腹胀行短期胃肠减压及完全胃肠道外营养，1例因纳差再次入院治疗；术后伤口愈合不良清创缝合1例。所有患者均痊愈出院，心功能改善，心绞痛症状消失。结论对于高龄患者，非体外循环冠状动脉旁路移植术疗效满意；胃肠功能、呼吸功能及手术耐受力为影响高龄患者围手术期恢复较为突出的因素，应采取更为积极的治疗和应对策略。

Citation： 张仁腾, 姜辉, 葛玉光, 孟庆涛, 高昊, 唐传乙. Perioperative Efcacy on Coronary Artery Bypass Grafing in Elderly Patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(5): 502-505. doi: 10.7507/1007-4848.20150130 Copy

1.	张仁腾, 姜辉, 王辉山, 等.桡动脉桥血管应用于冠状动脉旁路移植术的围手术期疗效分析.中国胸心血管外科临床杂志, 2013, 10(5):538-541.
2.	Kamiya H, Tanzeem N, Akhyari P, et al. Impact of severe postoperative complications afer cardiac surgery on mortality in patients aged over 80 years. Ann Thorac Cardiovasc Surg, 2013, 7(31):1-7.
3.	Hikmet I, Suat B. Early results of combined and staged coronary bypass and carotid endarterectomy in advanced age patients in single centre. Open Cardiovasc Med J, 2009, 3(1):8-14.
4.	Siminelakis S, Kotsanti A, Siafakas M, et al. Is there any difference in carotid stenosis between male and female patients undergoing coronary artery bypass grafing? Interact Cardiovasc Torac Surg, 2009, 11(5):823-826.
5.	廖远强, 吴德华, 潘楚雄.体外循环冠状动脉旁路移植术的麻醉处理.四川医学, 2008, 3(3):277-278.
6.	王嵘, 李立环.非体外循环冠状动脉旁路移植术的病理生理与麻醉处理.临床麻醉学杂志, 2008, 3(3):269-271.
7.	张南滨, 汪曾炜, 王辉山, 等.重症冠状动脉旁路移植手术围手术期IABP的临床应用.心肺血管病杂志, 2006, 8(4):242-243.
8.	邓勇志, 孙宗全, 马捷, 等.局部缺血预处理在冠状动脉旁路移植术中对右心功能的影响.山西医科大学学报, 2004, 8(4):363-366.
9.	Laurikka J, Wu ZK, Iisalo P. Regional ischemic preconditioning enhances myocardial performance in off-pump coronary artery bypass grafing. Chest, 2002, 121(4):1183-1189.
10.	董国华.体外循环相关消化系统损伤与保护.心血管外科杂志(电子版), 2013, 3(1):4-7.
11.	Bierbach B, Bomberg H, Pritzer H, et al. Off-pump coronary artery bypass prevents visceral organ damage. Interact Cardiovasc Torac Surg, 2014, 18(6):717-726.
12.	Van Boven WJ, Gerritsen WB, Driessen AH, et al. Minimised closed circuit coronary artery bypass grafting in the elderly is associated with lower levels of organ-specific biomarkers:a prospective randomised study. Eur J Anaesthesiol. 2013, 30(11):685-694.
13.	穆军升, 周帆, 张健群, 等. 80岁以上老年患者冠状动脉旁路移植术65例临床分析.中国胸心血管外科临床杂志, 2011, 18(5):464-465.
14.	Mamoun NF, Xu M, Sessler DI, et al. Propensity matched comparison of outcomes in older and younger patients after coronary artery bypass graf surgery. Ann Torac Surg, 2008, 85(6):1974-1979.
15.	Nicolini F, Molardi A, Verdichizzo D, et al. Coronary artery surgery in octogenarians:evolving strategies for the improvement in early and late results. Heart Vessels. 2012, 27(6):559-567.

1. 张仁腾, 姜辉, 王辉山, 等.桡动脉桥血管应用于冠状动脉旁路移植术的围手术期疗效分析.中国胸心血管外科临床杂志, 2013, 10(5):538-541.
2. Kamiya H, Tanzeem N, Akhyari P, et al. Impact of severe postoperative complications afer cardiac surgery on mortality in patients aged over 80 years. Ann Thorac Cardiovasc Surg, 2013, 7(31):1-7.
3. Hikmet I, Suat B. Early results of combined and staged coronary bypass and carotid endarterectomy in advanced age patients in single centre. Open Cardiovasc Med J, 2009, 3(1):8-14.
4. Siminelakis S, Kotsanti A, Siafakas M, et al. Is there any difference in carotid stenosis between male and female patients undergoing coronary artery bypass grafing? Interact Cardiovasc Torac Surg, 2009, 11(5):823-826.
5. 廖远强, 吴德华, 潘楚雄.体外循环冠状动脉旁路移植术的麻醉处理.四川医学, 2008, 3(3):277-278.
6. 王嵘, 李立环.非体外循环冠状动脉旁路移植术的病理生理与麻醉处理.临床麻醉学杂志, 2008, 3(3):269-271.
7. 张南滨, 汪曾炜, 王辉山, 等.重症冠状动脉旁路移植手术围手术期IABP的临床应用.心肺血管病杂志, 2006, 8(4):242-243.
8. 邓勇志, 孙宗全, 马捷, 等.局部缺血预处理在冠状动脉旁路移植术中对右心功能的影响.山西医科大学学报, 2004, 8(4):363-366.
9. Laurikka J, Wu ZK, Iisalo P. Regional ischemic preconditioning enhances myocardial performance in off-pump coronary artery bypass grafing. Chest, 2002, 121(4):1183-1189.
10. 董国华.体外循环相关消化系统损伤与保护.心血管外科杂志(电子版), 2013, 3(1):4-7.
11. Bierbach B, Bomberg H, Pritzer H, et al. Off-pump coronary artery bypass prevents visceral organ damage. Interact Cardiovasc Torac Surg, 2014, 18(6):717-726.
12. Van Boven WJ, Gerritsen WB, Driessen AH, et al. Minimised closed circuit coronary artery bypass grafting in the elderly is associated with lower levels of organ-specific biomarkers:a prospective randomised study. Eur J Anaesthesiol. 2013, 30(11):685-694.
13. 穆军升, 周帆, 张健群, 等. 80岁以上老年患者冠状动脉旁路移植术65例临床分析.中国胸心血管外科临床杂志, 2011, 18(5):464-465.
14. Mamoun NF, Xu M, Sessler DI, et al. Propensity matched comparison of outcomes in older and younger patients after coronary artery bypass graf surgery. Ann Torac Surg, 2008, 85(6):1974-1979.
15. Nicolini F, Molardi A, Verdichizzo D, et al. Coronary artery surgery in octogenarians:evolving strategies for the improvement in early and late results. Heart Vessels. 2012, 27(6):559-567.

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