摘要
目的 介绍 70岁以上高龄患者行冠状动脉旁路移植术 (CABG)的结果和围术期处理策略。 方法 对 70岁以上患者行 CABG 12 1例 ,119例 (98.3% )为不稳定型心绞痛 ,113例 (93.4 % )合并其他疾病。 80例 (6 6 .1% )采用非体外循环心脏不停跳 CABG(OPCAB) ,4 1例 (33.9% )选择常规体外循环 CABG(CCABG) ;胸膜外技术游离左乳内动脉 (L IMA) ,保持胸膜腔完整 ,常规将 L IMA与左前降支 (L AD)吻合 ,其余桥用大隐静脉 (SV)。术中使用即时超声血流仪 (TTFM)测量移植血管血流 ,保证吻合口通畅。术后加强物理治疗和营养支持 ,严格控制血糖于 6～ 10 mmol/L。结果 行 CCABG患者移植血管 3.0 8± 0 .75支 ,OPCAB患者 2 .2 4± 0 .82支 ,110例 (90 .9% )使用 L IMA。全组死亡1例 (急诊手术 ) ,死亡率 0 .8% ,死于多器官功能衰竭 ;发生并发症 4例 (3.3% )。术后呼吸机使用时间 OPCAB患者10 .0 4± 5 .6 8小时 ,CCABG患者 2 1.4 6± 14 .5 4小时 ;住 ICU时间 2 .6 5± 1.4 5天 ,术后 12 .2 2± 5 .5 6天出院。 结论 充分评估手术风险 ,选择恰当的手术方案 ,经过缜密的围术期处理 。
Objective To introduce the results and strategy of perioperative management undergo coronary artery bypass grafting (CABG) for patients older than 70. Methods One hundred and twenty one patients, 93.4%(113/121) of whom was complicated with other diseases, were retrospectively studied. Off-pump CABG (OPCAB) was used in 80 cases (66.1%). For the rest patients with severely compromised heart function or small target vessel with diffuse lesion, conventional CABG (CCABG) was selected. Left internal mammary artery (LIMA) was harvested leaving pleural cavity intact and grafted to left anterior descending artery (LAD). Saphenous vein(SV) was utilized for other anastomoses. Transit-time flowmeter (TTFM) was utilized to make sure that grafts were patent with satisfactory blood flow. Procedure of sternotomy and chest closure was carefully performed to decrease the complication of mediastinitis. Adequate nutrition and gradually increased physical activity were encouraged for 'fast-track'. Results Grafts were 3.08±0.75 for CCABG and 2.24±0.82 for OPCAB . LIMA was used in 90.9%(110/121) patients. One patient receiving emergency operation died of multiple organ failure syndrome resulting in mortality of 0.8%. The incidence of complication was 3.3%(4/121). The others recovered smoothly without any complication. Intubation time of OPCAB(10.04±5.68 h) was significantly shorter than that of CCABG(21.46±14.54 h). Patients were discharged within 12.22±5.56 days after operation. Conclusion Good short term result, namely low incidence of mortality and complication, could be obtained in patients older than 70 who underwent CABG through meticulous perioperative management.
出处
《中国胸心血管外科临床杂志》
CAS
2004年第3期165-167,共3页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
70岁
冠状动脉旁路移植术
非体外循环
围术期处理
Off-pump
Cardiopulmonary bypass
Coronary artery bypass grafting
Old age
Perioperative management
