降低高龄冠状动脉旁路移植手术风险的研究.docVIP

降低高龄冠状动脉旁路移植手术风险的研究 作者：牛兆倬,池一凡,侯文明 作者单位：青岛市市立医院心脏外科，山东 青岛 266011 【摘要】 目的 探讨降低高龄病人冠状动脉旁路移植术(CABG)风险的方法。方法 回顾分析2004年11月～2006年11月在我院行CABG的41例年龄大于70岁病人的临床资料，其中行Onpump手术32例，Offpump手术9例。Onpump手术采用顺逆灌冷氧合血心肌保护法。40例术中使用左侧乳内动脉与大隐静脉做旁路移植材料，行乳内动脉与前降支吻合、大隐静脉与其余病变冠状动脉吻合。围手术期应用预防性治疗方案。结果 1例病人术后2周突发腹膜后出血，经抢救无效死亡。余均治愈出院，术后心绞痛缓解。术后哮喘发作2例，房颤4例，上消化道大出血1例，脑栓塞致左侧肢体偏瘫1例。结论 综合性治疗措施可有效降低高龄冠CABG手术风险。 【关键词】 冠状动脉疾病；冠状动脉旁路移植术；降低风险行为 　　STUDY ON DECREASEING THE RISK OF CORONARY ARTERY BYPASS GRAFTING IN AGED PATIENTS 　　 　　NIU ZHAOZHUO, CHI YIFAN, HOU WENMING, et al 　　(Department of Cardiac Surgery, Qingdao Municipal Hospital, Qingdao 266011, China); 　　［ABSTRACT］ Objective To study the way of decreasing the risk of coronary artery bypass graft (CABG) in aged patients.Methods Clinical data of 41 senior patients (70 years old) underwent CABG were retrospectively reviewed, in which, 32 with onpump operation and nine with offpump technic. The antegrade and retrograde perfusion with cold blood cardioplegia were used in onpump CABG operations. The left internal mammary artery was anatomosed with left anterior descending branch. During the perioperation period, the preventive methods was provided to low the risk. Results One patient died of sudden retroperitoneal hemorrhage after two weeks. The others were cured and discharged without angina. Asthma occurred in two patients, atrial fibrillation in four, upper gastrointestinal tract hemorrhage in one and semiplegia caused by cerebral embolism in one after surgery.Conclusion The comprehensive treatment could effectively decrease the risk of CABG for old patients. 　　［KEY WORDS］ Coronary disease; Coronary artery bypass; Risk reduction behavior 　　随着外科技术的进步和老龄化社会的来临，冠状动脉旁路移植术（CABG）被更多地应用于年老体弱、病情复杂的人群[1]。高龄冠心病病人多伴有糖尿病、高血压、慢性阻塞性肺疾病、肾脏疾病等，其围手术期低心排综合征、脑血管意外、呼吸功能衰竭、胃肠道并发症、切口感染、肾衰竭的发生率增高[2]。我们根据高龄病人特点，选择全面和有针对性的治疗措施，有效降低了CABG手术并发症的发生率，现报告如下。 　　1 资料和方法 　　1.1 一般资料 　　20