摘要
目的探讨高龄患者行冠状动脉旁路移植术(CABG)的安全性及围术期管理。方法选择2015年1月至2020年10月于山东济宁医学院附属医院接受CABG手术的年龄≥75岁患者112例,其中男性83例,女性29例,年龄75~89(77.2±1.9)岁,根据不同的手术方法,分为对照组(体外循环)和观察组(非体外循环),对两组患者的术前、围术期并发症及病死率进行分析。结果两组术前情况、手术时间、桥血管数和病死率对比无显著差异(P>0.05);观察组24h引流量(338.7±82.5)ml和围术期输血量(279.1±67.2)ml均低于对照组的(579.1±132.7)ml及(338.7±82.5)ml,差异有统计学意义(P<0.05);观察组呼吸机辅助时间(9.4±3.7)h和ICU停留时间(43.6±11.9)h较对照组的(20.2±6.1)h和(78.4±17.8)h短,差异有统计学意义(P<0.05);观察组与对照组分别发生心律失常8例(12.70%)和14例(28.57%)、肾功能不全4例(6.35%)和9例(18.37%)、肺部感染11例(17.46%)和14例(28.57%)、卒中2例(3.17%)和4例(8.16%),差异有统计学意义(P<0.05)。结论高龄患者行CABG安全有效,非体外循环CABG输血量少,并发症发生率低,更利于患者恢复。
Objective To investigate the safety and perioperative management of coronary artery bypass grafting(CABG) in patients aged over 75. Methods From January 2015 to October 2020 in the affiliated hospital of Jining medical university 112 patients(older than 75 years) undergoing CABG were selected, with 29 females and 83 males at age of 75~89(77.2 + 1.9) years. According to the different operation methods, the patients were divided into the control group(on-pump) and observation group(off-pump). The preoperative and perioperative complications and mortality were retrospectively analyzed. Results There were no significant differences between the two groups in preoperative condition, operative time, number of grafts and mortality(P>0.05). Both 24 h drainage volume after the operation(338.7±82.5)ml and perioperative transfusion volume(279.1±67.2)ml in the observation group were lower than that(579.1 ± 132.7)ml and(338.7 ± 82.5)ml in the control group, and the differences were statistically significant(P<0.05). Mechanical ventilation time(9.4 ± 3.7)h and ICU stay time(43.6±11.9)h in the observation group were shorter than that in the control group(20.2±6.1)h and(78.4±17.8)h and the differences were statistically significant(P<0.05). In both the 2 groups, arrhythmia occurred 8(12.70%) and 14(28.57%) cases, renal insufficiency 4(6.35%) and 9(18.37%) cases, pulmonary infection 11(17.46%) and 14(28.57%) cases, and stroke 2(3.17%) and 4(8.16%) cases respectively;the differences were statistically significant(P<0.05). Conclusion CABG is safe and effective in the elderly patients aged over 75 years. off-pump CABG with less blood transfusion volume and lower complication rate, which is more beneficial to the patients’ recovery.
作者
李祥
宗良
倪良春
姚碧
刘朝亮
刘斌
LI Xiang;ZONG Liang;NI Liang-chun;YAO Bi;LIU Chao-liang;LIU Bin(Department of Cardiac Surgery,Affiliated Hospital of Jining Medical University,Jining 272029,China)
出处
《中国心血管病研究》
CAS
2021年第6期526-529,共4页
Chinese Journal of Cardiovascular Research
关键词
冠状动脉旁路移植术
冠心病
高龄
并发症
Coronary artery bypass grafting
Coronary artery disease
Advanced age
Complications
