中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2009年
3期
250-252
,共3页
徐根兴%薛松%申达甫%黄日太%刘沙%胡振雷%连锋%谢波%叶清%郑家豪%朱洪生
徐根興%薛鬆%申達甫%黃日太%劉沙%鬍振雷%連鋒%謝波%葉清%鄭傢豪%硃洪生
서근흥%설송%신체보%황일태%류사%호진뢰%련봉%사파%협청%정가호%주홍생
冠状动脉搭桥术%高龄
冠狀動脈搭橋術%高齡
관상동맥탑교술%고령
Coronary artery bypass grafting%Elderly age
目的 总结70岁以上高龄冠心病患者行冠状动脉搭桥术的早、中期结果和经验教训,以期提高手术治疗效果.方法 回顾性分析我院2006年12月至2007年12月86例70岁以上冠心病患者进行冠状动脉旁路移植术(CABG)的临床资料,其中行不停搏CABG 71例,体外循环下CABG 15例,同时行二尖瓣置换5例、主动脉瓣置换3例和室壁瘤切除1例.结果 1例术后死亡,死亡原因为术后肠穿孔.平均术后气管插管时间8 h,ICU停留时间(77.4±49.6)h,术后住院时间15 d,术后引流量平均530 ml.共有22例次术后发生各种不同的并发症.76例随访10～22个月,随访效果良好,心功能Ⅰ、Ⅱ级,无心绞痛、心肌梗死发生和晚期死亡.结论 高龄冠心病患者只要一般情况好,与一般患者相比病死率无明显提高;但高龄患者应注意术前呼吸功能的锻炼、心绞痛症状控制;不停搏CABG可显著降低术后并发症的发生率及院内病死率,为高龄CABG患者首选术式.
目的 總結70歲以上高齡冠心病患者行冠狀動脈搭橋術的早、中期結果和經驗教訓,以期提高手術治療效果.方法 迴顧性分析我院2006年12月至2007年12月86例70歲以上冠心病患者進行冠狀動脈徬路移植術(CABG)的臨床資料,其中行不停搏CABG 71例,體外循環下CABG 15例,同時行二尖瓣置換5例、主動脈瓣置換3例和室壁瘤切除1例.結果 1例術後死亡,死亡原因為術後腸穿孔.平均術後氣管插管時間8 h,ICU停留時間(77.4±49.6)h,術後住院時間15 d,術後引流量平均530 ml.共有22例次術後髮生各種不同的併髮癥.76例隨訪10～22箇月,隨訪效果良好,心功能Ⅰ、Ⅱ級,無心絞痛、心肌梗死髮生和晚期死亡.結論 高齡冠心病患者隻要一般情況好,與一般患者相比病死率無明顯提高;但高齡患者應註意術前呼吸功能的鍛煉、心絞痛癥狀控製;不停搏CABG可顯著降低術後併髮癥的髮生率及院內病死率,為高齡CABG患者首選術式.
목적 총결70세이상고령관심병환자행관상동맥탑교술적조、중기결과화경험교훈,이기제고수술치료효과.방법 회고성분석아원2006년12월지2007년12월86례70세이상관심병환자진행관상동맥방로이식술(CABG)적림상자료,기중행불정박CABG 71례,체외순배하CABG 15례,동시행이첨판치환5례、주동맥판치환3례화실벽류절제1례.결과 1례술후사망,사망원인위술후장천공.평균술후기관삽관시간8 h,ICU정류시간(77.4±49.6)h,술후주원시간15 d,술후인류량평균530 ml.공유22례차술후발생각충불동적병발증.76례수방10～22개월,수방효과량호,심공능Ⅰ、Ⅱ급,무심교통、심기경사발생화만기사망.결론 고령관심병환자지요일반정황호,여일반환자상비병사솔무명현제고;단고령환자응주의술전호흡공능적단련、심교통증상공제;불정박CABG가현저강저술후병발증적발생솔급원내병사솔,위고령CABG환자수선술식.
Objective To summarize the clinical experiences and early-to median effect of coronary artery bypass grafting(CABG)in patients aged 70 years or above.Methods From Dec.2006 to Dec.2007,86 patients aged 70 or above underwent CABG,of whom 71 cases underwent off-pump coronary artery bypass grafting(OPCAB),15 cases had CABG with cardiopulmonary bypass(CPB).5 cases underwent mitral valve replacement,3 underwent aortic valve replacement besides CABG,and one case underwent removal of ventricular aneurysm.Their clinical data were retrospectively analyzed.Results There was one case who died of enterobrosis after operation.The average ICU stay time was(77.4±49.6)h,the average postoperative stay time was 15 d,and the average drainage was 530 ml.22 postoperative complications were found.76 cases were followed up for 10-22 months.Follow up effect was better showing cardiac classification I-II and no angina pectoris,myocardial infarction and late death.Conclusion Patients with coronary heart disease in good condition will have not remarkable improvement in mortality as compared with ordinary patients but attention should be paid to their preoperative pulmonary function and angina pectoffs.OPCABG would have encouraging result in reducing the rate of postoperative complications and hospital death,which should be recommended as the first choice for the elderly patients.
