Tomita S, Watanabe G
Department of General and Cardiothoracic Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Kyobu Geka. 2005 Jul;58(8 Suppl):641-6.
The elderly patients of the ischemic heart disease have been increasing in recent years. From January 2001 to December 2004, 41 patients were aged 80 years or older underwent off-pump coronary artery bypass grafting (OPCAB) in our hospital. To perform OPCAB of elderly patient safely, we review presence of carotid artery stenosis and previous cerebral infarction preoperatively and use high thoracic epidural anesthesia (TEA) and coronary artery active perfusion system (CAPS) intraoperatively. TEA provides bradycardia and coronary vasodilatation which facilitate beating-heart surgery technically, and prevent intra- and postoperative arrhythmia. Comparing with before use of TEA, operating time and postoperative intubation time decreased significantly. Using CAPS anastomosis was performed under bloodless field and stable hemodynamics. There was no operative death and severe postoperative complication. In conclusion, with careful preoperative inspection and using TEA and CAPS, OPCAB can be performed safely in octogenarians.
近年来，缺血性心脏病老年患者数量不断增加。2001年1月至2004年12月，我院41例80岁及以上患者接受了非体外循环冠状动脉搭桥术（OPCAB）。为安全实施老年患者的OPCAB，我们术前评估颈动脉狭窄情况及既往脑梗死病史，并在术中采用高位胸段硬膜外麻醉（TEA）和冠状动脉主动灌注系统（CAPS）。TEA可导致心动过缓和冠状动脉扩张，在技术上便于心脏不停跳手术，并预防术中和术后心律失常。与使用TEA前相比，手术时间和术后插管时间显著缩短。使用CAPS可在无血视野和稳定血流动力学状态下进行吻合。无手术死亡及严重术后并发症。总之，通过仔细的术前检查以及使用TEA和CAPS，可为80岁以上老人安全实施OPCAB。
