70岁及以上老年患者体外循环与非体外循环冠状动脉旁路移植术的对比研究

摘要

目的：比较70岁及以上老年患者体外循环和非体外循环冠状动脉旁路移植术的疗效。方法回顾性分析2006年1月-2013年6月首都医科大学附属北京世纪坛医院心脏外科收治的单纯接受冠状动脉旁路移植术的70岁及以上老年冠心病患者106例，并按是否行体外循环冠状动脉旁路移植术分为体外循环组（45例）和非体外循环组（61例）。体外循环组麻醉成功后全身肝素化，经升主动脉和右心房插管建立体外循环；非体外循环组麻醉成功后全身半量肝素化，应用 Medtronic 心脏固定器。观察患者术中的静脉桥血管远端吻合口数、手术操作时间（从切皮到缝皮完毕）、术后重症监护病房（ICU）治疗时间、术后机械通气时间、术后住院时间、术后心房纤颤持续时间、住院费用；术后3个月复查超声心动图测定左心室射血分数（LVEF）和左心室舒张末期内径（LVEDD）。结果两组患者术中的静脉桥血管远端吻合口数、手术操作时间及术后住院时间比较，差异均无统计学意义（P ﹥0.05）。非体外循环组患者术后 ICU 治疗时间、术后机械通气时间均短于体外循环组（P ﹤0.05）；非体外循环组患者术后心房纤颤持续时间﹥10 min 的发生率低于体外循环组（P ﹤0.05）；体外循环组患者的住院费用低于非体外循环组（P ﹤0.05）。术后3个月两组患者的 LVEF、LVEDD 比较，差异无统计学意义（P ﹥0.05）；且两组患者的 LVEF、LVEDD 分布情况比较，差异无统计学意义（P ﹥0.05）。结论非体外循环冠状动脉旁路移植术相比于体外循环冠状动脉旁路移植术对70岁及以上老年患者的疗效可能较好，为临床治疗提供了有益的参考依据。%Objective To compare the outcomes of off - pump and on - pump coronary artery bypass grafting(CABG) in patients above 70 years old. Methods 106 coronary heart disease(CHD)patients above 70 years old underwent CABG in the department of cardiac surgery of Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2006 to June 2013 were retrospectively analyzed,and were divided into on - pump group(45 cases)and off - pump group(61 cases). The on - pump group was given systemic heparinization and cannula via ascending aorta and right atrium. The off - pump group was given half - dose systemic heparinization and Medtronic heart holder. The mean number of distal anastomoses,operation time, ICU treatment time,mechanical ventilation supporting time,postoperative hospitalization time,postoperative atrial fibrillation time and medical cost were recorded. The LVEF and LVEDD were reviewed three months after operation. Results The number of distal anastomoses,operation time and postoperative hospitalization time between the two groups showed no statistically signifi-cant difference(P ﹥ 0. 05). The postoperative ICU treatment time and mechanical ventilation time of the off - pump group were shorter than the on - pump group(P ﹤ 0. 05). The incidence of atrial fibrillation ﹥ 10 min in off - pump group was lower than the on - pump group(P ﹤ 0. 05). The medical cost of the on - pump group was lower than the off - pump group(P ﹤ 0. 05). Three months after operation,the LVEF and LVEDD between the two groups showed no statistically significant difference(P ﹥ 0. 05), and the distribution of LVEF and LVEDD also showed no statistically significant difference(P ﹥ 0. 05). Conclusion The off -pump CABG may have better effect on patients above 70 years old,which will provide helpful evidence for clinical treatment of the disease.