摘要
目的 探讨80岁以上高龄患者冠状动脉旁路移植术的临床效果和围术期管理特点.方法 24例80岁以上患者单纯行冠状动脉旁路移植术(CABG),其中体外循环下2例,非体外循环下22例,胸骨下端小切口2例,应用主动脉近端吻合器5例.结果 死亡2例,死亡率8.33%.术后低心排出量3例,心房纤颤9例,低氧血症2例,急性肾功能损伤2例,术后出现精神症状3例,胸部切口感染1例,以上均经治疗后痊愈出院.呼吸机辅助时间(11.3±8.6)h.应用主动脉内球囊反搏2例.住ICU时间(3.15±1.74)d,术后住院时间(18.47±5.32)d.生存患者随访3～37个月,1例死亡,17例患者心绞痛消失,占77.3%,心功能Ⅱ级.结论 根据高龄病人的特点,采取适当的术前准备,手术方案和术后管理,80岁以上患者行CABG的临床结果 可以接受.
Abstract
Objective To discuss the results and strategy of perioperative management in patients of octogenarians undergoing coronary artery bypass grafting (CABG). Methods From January 2005 to November 2009 twenty-four patients of octogenarians underwent isolated CABG. Two patients underwent conventional (on-pump) CABG and 22 patients underwent off-pump CABG. The proximal aortic anastomoses were used in 5 cases and lewer half ministernotomy technique was used for 2 patients in CABG. Results Two deaths occurred perioperatively ( mortality was 8.33％ ). Major postoperative complications included low cardiac output in 3 patients, respiratory dysfunction in 2 patients, sternal wound infection in 1 patient, and acute kidney injury in 2 patients. The atrial fibrillation occurred in 9 patients and 3 patients complicated mental disorder postoperatively. Intraaortic balloon pump (IABP) was used in 2 patients. The ventilation time was 11.3 ± 8.6 hours. The intensive care unit stay was 3.15 ± 1.74 days and postoperative in-hospital stay was 18.47 ± 5.32 days. Twenty-two patients were followed up 3 - 37 months. One patient died during the follow-up period. The survivors were relieved from symptom. Conclusion Clinical outcome of octogenarians undergoing CABG is acceptable. Intensive perioperative treatment is important to reduce the morbidity and mortality.
NETL
NSTL
维普
万方数据