CAJ | 학술논문

目的总结70岁以上患者冠状动脉旁路移植手术中应用乳内动脉的利弊.方法 2010年7月1日至2012年8月20日,1471例70岁以上患者行单纯冠状动脉旁路移植手术共,占同期6156例单纯CABG手术者的23.10％.其中男1030例,女441例,年龄(73.3±3.9)岁.1395例采用非体外循环冠状动脉旁路移植术(off-pump CABG),76例采用体外循环(on-pump CABG),其中12例采用体外循环不停跳(on-pump beating heart CABG).旁路移植移植旁路血管(3.12±0.68)支.按移植血管材料分为2组:A组:564例全部应用大隐静脉；B组:907例患者应用左乳内动脉建立与左前降支旁路移植手术,其中42例应用桡动脉及胃网膜右动脉进行全动脉化旁路移植手术,其余靶血管均应用大隐静脉作为血管移植物旁路移植.结果 A组死亡12例(2.12％),B组死亡19例(2.09％),组间差异无统计学意义.B组术后早期引流量明显高于A组,二次开胸止血、恶性心律失常、脑卒中、伤口愈合不良和IABP使用例数等指标两组之间差异均无统计学意义.结论 70岁以上高龄患者旁路移植冠状动脉旁路移植选择左乳内动脉作为左前降支的旁路移植旁路血管材料,不增加手术死亡和术后严重并发症的发生率.乳内动脉在远期通畅率方面的优势明显,建议70岁以上高龄患者旁路移植优先选择左乳内动脉作为左前降支的旁路移植旁路移植血管.
목적 총결70세이상환자관상동맥방로이식수술중응용유내동맥적리폐.방법 2010년7월1일지2012년8월20일,1471례70세이상환자행단순관상동맥방로이식수술공,점동기6156례단순CABG수술자적23.10％.기중남1030례,녀441례,년령(73.3±3.9)세.1395례채용비체외순배관상동맥방로이식술(off-pump CABG),76례채용체외순배(on-pump CABG),기중12례채용체외순배불정도(on-pump beating heart CABG).방로이식이식방로혈관(3.12±0.68)지.안이식혈관재료분위2조:A조:564례전부응용대은정맥；B조:907례환자응용좌유내동맥건립여좌전강지방로이식수술,기중42례응용뇨동맥급위망막우동맥진행전동맥화방로이식수술,기여파혈관균응용대은정맥작위혈관이식물방로이식.결과 A조사망12례(2.12％),B조사망19례(2.09％),조간차이무통계학의의.B조술후조기인류량명현고우A조,이차개흉지혈、악성심률실상、뇌졸중、상구유합불량화IABP사용례수등지표량조지간차이균무통계학의의.결론 70세이상고령환자방로이식관상동맥방로이식선택좌유내동맥작위좌전강지적방로이식방로혈관재료,불증가수술사망화술후엄중병발증적발생솔.유내동맥재원기통창솔방면적우세명현,건의70세이상고령환자방로이식우선선택좌유내동맥작위좌전강지적방로이식방로이식혈관.
Objective To review the outcome of coronary artery bypass grafting (CABG) using left internal thoracic artery (LITA) grafts in these patients aged more than 70 years old.Methods 1471 patients aged more than 70 years old[mean (73.3 ± 3.9) years] from July 2010 through August 2012,who underwent CABG in Anzhen hospital,form the cohort of this study.Among them,1395 cases underwent off-pump CABG,while 76 cases underwent on-pump CABG which includes onpump beating heart CABG in 12 cases.The average number of the grafts is 3.12 ±0.68.All of the patients were divided into two groups on base of the graft:Group A:only saphenous vein graft was used in 564 cases; Group B:The left internal thoracic artery to the left anterior descending artery was used in 907 cases,which also include total arterial grafting,facilitated by the use of the radial artery,right gastroepiploic artery was operated in 42 cases,beside these artery grafts,saphenous vein graft was used to anastomosis with other vessels.Results Operative mortality was 2.12％ in group A and 2.09％ in group B.There was no significance between the 2 groups.The volume of blood drainage was larger in group B than that in group A.At the same time,there was no significance in the incidence rate of second thoractomy,malignant arrhythmia,stroke,poor wound healing,and usage of IABP between the 2 groups.Conclusion It did not increase the mortality and morbidity of serious complications using the left internal thoracic artery to the left anterior descending artery in those elderly patients aged more than 70 years old during the CABG operation.With consideration of the obvious advantages in the long term patency,LITA was proposed to be used in CABG even in those age ＞ 70 patients.