Clinical Results of Coronary Artery Bypass Grafting in the Geriatric Patients Above 75 Years_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

孫忠東 ¹ , 池一凡 ² , 矯艷 ¹ , 孫龍 ² , 生偉 ² ,  任冠樺 ¹

1. ;
2. ;

Corresponding?author：

任冠樺, Email: 任冠樺，Email: szd118@sina.com

Keywords：

冠狀動脈旁路移植術; 冠狀動脈粥樣硬化性心臟病; 術后處理; 老年; 心肌缺血; 并發癥

DOI：

10.7507/1007-4848.20160094

Video：

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目的分析75歲以上高齡冠心病患者行冠狀動脈旁路移植術（CABG）的治療效果和臨床經驗。方法回顧性分析山東省濰坊市人民醫院和青島市市立醫院自2005年1月至2014年1月109例75歲以上行CABG術患者的臨床資料。其中，男63例、女46例，平均年齡（78.1±4.2）歲，均為多支血管病變。術前心功能分級（NYHA） Ⅳ級23例、Ⅲ級57例、Ⅱ級29例。術中行非體外循環CABG （OPCABG） 92例，體外循環下行CABG （on pump CABG）術9例，體外循環輔助心臟不停跳下CABG （on pump beating heart CABG）術8例。結果平均移植血管（2.5±1.4）支，圍術期死亡4例，死亡率3.7%。其中，低心排血量綜合征死亡1例，心律失常心室顫動死亡1例，腎衰和胃腸道并發癥導致多器官衰竭死亡2例。術后主要并發癥為心律失常、低心排血量綜合征和肺部感染。105例生存患者95例獲得隨訪，隨訪6～90 （45±26）個月，隨訪率90.5%。隨訪期間心源性死亡1例，非心源性死亡4例。患者心功能分級（NYHA）Ⅰ級81例，Ⅱ級18例，Ⅲ級2例，心絞痛消失。結論 75歲以上冠心病患者行冠狀動脈旁路移植術可改善患者癥狀，緩解心絞痛，提高生活質量，具有良好的近中期效果。

Citation： 孫忠東, 池一凡, 矯艷, 孫龍, 生偉, 任冠樺. Clinical Results of Coronary Artery Bypass Grafting in the Geriatric Patients Above 75 Years. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(4): 405-407. doi: 10.7507/1007-4848.20160094 Copy

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2.	Yanagawa B, Algarni KD, Yau TM, et al. Improving results for nary artery bypass graft surgery in the elderly. Eur J Cardioac Surg, 2012, 42(3): 507-512.
3.	Sündermann S, Dademasch A, Praetorius J, et al. Comprehensive assessment of frailty for elderly high-risk patients undergoing cardiac surgery. Eur J Cardiothorac Surg, 2011, 39(1): 33-37.
4.	Reents W, Hilker M, Brgermann J, et al. Acute kidney injury after on-pump or off-pump coronary artery bypass grafting in elderly patients. Ann Thorac Surg, 2014, 98(1): 9-15.
5.	Harskamp RE, Puskas JD, Tijssen JG, et al. Comparison of hybrid coronary revascularization versus coronary artery bypass grafting in patients ≥65 years with multivessel coronary artery disease. Am J Cardiol, 2014, 114(2): 224-229.
6.	Jongman RM, Zijlstra JG, Kok WF, et al. Off-pump CABG surgery reduces systemic inflammation compared with on-pump surgery but does not change systemic endothelial responses: A prospective randomized study. Shock, 2014, 42(2): 121-128.
7.	Caceres M, Weiman DS. Optimal timing of coronary artery bypass grafting in acute myocardial infarction. Ann Thorac Surg, 2013, 95(1): 365-372.
8.	池一凡, 孫忠東, 侯文明, 等. 急性心肌梗死外科治療臨床效果和手術時機的探討. 中國胸心血管外科臨床雜志, 2011, 18(6): 531-535.
9.	池一凡, 牛兆倬, 侯文明, 等. 急性心肌梗死合并心源性休克手術治療六例. 中國胸心血管外科臨床雜志, 2011, 18(1): 77-79.
10.	謝波, 薛松, 連鋒, 等. 急性心肌梗死近期行非體外循環冠狀動脈旁路移植術的臨床分析. 中國胸心血管外科臨床雜志, 2012, 19(5): 511-515.
11.	Bak E, Marcisz C. Quality of life in elderly patients following coronary artery bypass grafting. Patient Prefer Adherence, 2014, 14(8): 289-299.

1. Tu JV, Jaglal SB, Naylor CD. Multicenter validation of a risk index for mortality, intensive care unit stay, and over all hospital length of stay after cardiac surgery. Steering Committee of the Provincial Adult Cardiac Care Network of Ontario. Circulation, 1995, 91(3): 677-684.
2. Yanagawa B, Algarni KD, Yau TM, et al. Improving results for nary artery bypass graft surgery in the elderly. Eur J Cardioac Surg, 2012, 42(3): 507-512.
3. Sündermann S, Dademasch A, Praetorius J, et al. Comprehensive assessment of frailty for elderly high-risk patients undergoing cardiac surgery. Eur J Cardiothorac Surg, 2011, 39(1): 33-37.
4. Reents W, Hilker M, Brgermann J, et al. Acute kidney injury after on-pump or off-pump coronary artery bypass grafting in elderly patients. Ann Thorac Surg, 2014, 98(1): 9-15.
5. Harskamp RE, Puskas JD, Tijssen JG, et al. Comparison of hybrid coronary revascularization versus coronary artery bypass grafting in patients ≥65 years with multivessel coronary artery disease. Am J Cardiol, 2014, 114(2): 224-229.
6. Jongman RM, Zijlstra JG, Kok WF, et al. Off-pump CABG surgery reduces systemic inflammation compared with on-pump surgery but does not change systemic endothelial responses: A prospective randomized study. Shock, 2014, 42(2): 121-128.
7. Caceres M, Weiman DS. Optimal timing of coronary artery bypass grafting in acute myocardial infarction. Ann Thorac Surg, 2013, 95(1): 365-372.
8. 池一凡, 孫忠東, 侯文明, 等. 急性心肌梗死外科治療臨床效果和手術時機的探討. 中國胸心血管外科臨床雜志, 2011, 18(6): 531-535.
9. 池一凡, 牛兆倬, 侯文明, 等. 急性心肌梗死合并心源性休克手術治療六例. 中國胸心血管外科臨床雜志, 2011, 18(1): 77-79.
10. 謝波, 薛松, 連鋒, 等. 急性心肌梗死近期行非體外循環冠狀動脈旁路移植術的臨床分析. 中國胸心血管外科臨床雜志, 2012, 19(5): 511-515.
11. Bak E, Marcisz C. Quality of life in elderly patients following coronary artery bypass grafting. Patient Prefer Adherence, 2014, 14(8): 289-299.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Results of Coronary Artery Bypass Grafting in the Geriatric Patients Above 75 Years

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