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

Authors：

 張仁騰 , 姜輝 , 葛玉光 , 孟慶濤 , 高昊 , 唐傳乙

沈陽軍區總醫院?心血管外科（沈陽?110016）;

Corresponding?author：

張仁騰, Email: zhangrenteng@163.com

Keywords：

高齡患者; 冠心病; 冠狀動脈旁路移植; 圍手術期; 并發癥

DOI：

10.7507/1007-4848.20150130

Video：

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目的總結75歲以上高齡冠心病患者行冠狀動脈旁路移植術（CABG）的圍手術期臨床經驗，以提高手術療效。方法 2014年2～6月沈陽軍區總醫院心外科為20例75～84歲冠狀動脈粥樣硬化患者行非體外循環冠狀動脈旁路移植術，其中男11例、女9例，主要病變均為三支冠狀動脈嚴重狹窄或伴左主干狹窄，其中5例患者伴急性心肌梗死，所有患者均為限期手術。分析全組手術時間、住院時間、圍手術期并發癥、術后結果等。結果全組均采用左乳內動脈吻合前降支，大隱靜脈吻合其他分支，平均橋血管數量為3.2支；平均手術時間3.3 h；術后平均呼吸機輔助時間9.6 h；術后平均重癥監護時間26.4 h；術后平均住院時間為12.3 d。術后出現陣發性心房顫動3例；術后呼吸機輔助期間低氧血癥2例，術后因咳痰無力及誤吸并發嚴重肺炎1例；術后明顯腹脹、納差6例，其中1例因腹脹行短期胃腸減壓及完全胃腸道外營養，1例因納差再次入院治療；術后傷口愈合不良清創縫合1例。所有患者均痊愈出院，心功能改善，心絞痛癥狀消失。結論對于高齡患者，非體外循環冠狀動脈旁路移植術療效滿意；胃腸功能、呼吸功能及手術耐受力為影響高齡患者圍手術期恢復較為突出的因素，應采取更為積極的治療和應對策略。

Citation： 張仁騰, 姜輝, 葛玉光, 孟慶濤, 高昊, 唐傳乙. 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.	張仁騰, 姜輝, 王輝山, 等.橈動脈橋血管應用于冠狀動脈旁路移植術的圍手術期療效分析.中國胸心血管外科臨床雜志, 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.	廖遠強, 吳德華, 潘楚雄.體外循環冠狀動脈旁路移植術的麻醉處理.四川醫學, 2008, 3(3):277-278.
6.	王嶸, 李立環.非體外循環冠狀動脈旁路移植術的病理生理與麻醉處理.臨床麻醉學雜志, 2008, 3(3):269-271.
7.	張南濱, 汪曾煒, 王輝山, 等.重癥冠狀動脈旁路移植手術圍手術期IABP的臨床應用.心肺血管病雜志, 2006, 8(4):242-243.
8.	鄧勇志, 孫宗全, 馬捷, 等.局部缺血預處理在冠狀動脈旁路移植術中對右心功能的影響.山西醫科大學學報, 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.	董國華.體外循環相關消化系統損傷與保護.心血管外科雜志(電子版), 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.	穆軍升, 周帆, 張健群, 等. 80歲以上老年患者冠狀動脈旁路移植術65例臨床分析.中國胸心血管外科臨床雜志, 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. 張仁騰, 姜輝, 王輝山, 等.橈動脈橋血管應用于冠狀動脈旁路移植術的圍手術期療效分析.中國胸心血管外科臨床雜志, 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. 廖遠強, 吳德華, 潘楚雄.體外循環冠狀動脈旁路移植術的麻醉處理.四川醫學, 2008, 3(3):277-278.
6. 王嶸, 李立環.非體外循環冠狀動脈旁路移植術的病理生理與麻醉處理.臨床麻醉學雜志, 2008, 3(3):269-271.
7. 張南濱, 汪曾煒, 王輝山, 等.重癥冠狀動脈旁路移植手術圍手術期IABP的臨床應用.心肺血管病雜志, 2006, 8(4):242-243.
8. 鄧勇志, 孫宗全, 馬捷, 等.局部缺血預處理在冠狀動脈旁路移植術中對右心功能的影響.山西醫科大學學報, 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. 董國華.體外循環相關消化系統損傷與保護.心血管外科雜志(電子版), 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. 穆軍升, 周帆, 張健群, 等. 80歲以上老年患者冠狀動脈旁路移植術65例臨床分析.中國胸心血管外科臨床雜志, 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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Perioperative Efcacy on Coronary Artery Bypass Grafing in Elderly Patients

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