【摘要】：目的分析75歲以上高齡患者行非體外循環(huán)下冠脈旁路移植術(shù)(OPCAB)的遠(yuǎn)期療效及其危險(xiǎn)因素。方法 2000年11月~2013年11月,97例75歲以上高齡患者由同一術(shù)者完成非體外循環(huán)下冠脈旁路移植術(shù)。統(tǒng)計(jì)重癥監(jiān)護(hù)病房(ICU)時(shí)間、機(jī)械通氣時(shí)間、術(shù)后并發(fā)癥發(fā)生率及死亡率等圍術(shù)期結(jié)果。出院后隨訪包括全因死亡及主要心腦血管不良(MACCE)事件(心肌梗死、腦血管事件、重復(fù)再血管化)。結(jié)果圍術(shù)期死亡3例,在院死亡率3%,隨訪成功率93.81%,隨訪時(shí)間為(29-192)(95.61±34.07)個(gè)月。10年生存率為62%,10年MACCE事件免除率為47.4%。隨訪期間6例(6.8%)患者進(jìn)行了重復(fù)再血管化,12例(12.37%)患者出現(xiàn)腦血管事件,5例(5.15%)出現(xiàn)心梗。Logistic回歸分析顯示術(shù)前合并高血壓(OR=1.388,P=0.043)、糖尿病(OR=1.692,P=0.017)是高齡患者OPCAB術(shù)后遠(yuǎn)期MACCE事件的獨(dú)立風(fēng)險(xiǎn)預(yù)測因素,而不完全再血管化并不會(huì)增加術(shù)后主要心腦血管不良事件(MACCE)事件發(fā)生率。結(jié)論高齡冠心病患者行非體外循環(huán)下冠脈旁路移植術(shù)是一種安全有效的手術(shù)方法,遠(yuǎn)期效果滿意。高血壓、糖尿病是高齡患者OPCAB術(shù)后發(fā)生MACCE事件的危險(xiǎn)因素,但術(shù)后良好地控制血壓及血糖可以有效降低MACCE事件的發(fā)生率,而不完全再血管化并不會(huì)對遠(yuǎn)期療效產(chǎn)生不良影響。
[Abstract]:Objective to analyze the long-term efficacy and risk factors of off-pump coronary artery bypass grafting (OPCAB) in patients over 75 years old. Methods from November 2000 to November 2013, 97 patients over 75 years old underwent off-pump coronary artery bypass grafting. The perioperative results of (ICU) time, mechanical ventilation time, postoperative complications and mortality in intensive care unit (ICU) were counted. Follow-up after discharge included all-cause death and major cardiovascular and cerebrovascular adverse (MACCE) events (myocardial infarction, cerebrovascular events, repeated revascularization). Results three cases died during perioperative period, the mortality in hospital was 3%, the success rate of follow-up was 93.81%, the follow-up time was (29 鈮，

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