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冠状动脉旁路移植术对老年患者的影响。

Impact of coronary artery bypass grafting in elderly patients.

作者信息

Aikawa Priscila, Cintra Angélica Rossi Sartori, Leite Cleber Aparecido, Marques Ricardo Henrique, da Silva Claudio Tafarel Mackmillan, Afonso Max dos Santos, Paulitsch Felipe da Silva, Oss Evandro Augusto

机构信息

Hospital de Cardiologia Doutor Pedro Bertoni da Associação de Caridade da Santa Casa do Rio Grande, Rio Grande, RS, Brasil.

出版信息

Rev Bras Cir Cardiovasc. 2013 Mar;28(1):22-8. doi: 10.5935/1678-9741.20130005.

Abstract

OBJECTIVE

To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG) in patients > 65 years-old.

METHODS

Patients undergoing isolated on-pump CABG from December 1st 2010 to July 31th 2012 were divided in two groups: GE (elderly > 65 years-old, n=103) and GA (adults < 65 years-old, n=150). Preoperative data, intraoperative (as cardiopulmonar bypass time, aortic clamping time, time length of stay in mechanical ventilation--MV--and number of grafts), and postoperative variable (as morbidity, mortality and time length of stay in hospital) were analyzed during hospitalization.

RESULTS

In GE, the morbidity rate was greater than in GA (30% vs. 14%, P=0.004), but there was no difference in the mortality rate (5.8% vs. 2.0%, P=0.165). In GA, there was higher prevalence DM (39.6% vs. 27%, P=0.043) and smoking (32.2% versus 19.8%, P=0.042); and in GE, higher prevalence of stroke (17% vs. 6.7%, P=0.013). There was no difference between the groups regarding intraoperative variables. After multivariate analysis, age > 65-year-old was associated with greater morbidity, but it was not independent predictive factor for in-hospital mortality. Considering in-hospital mortality, stay in ward time length (P=0.006), cardiac (P=0.011) and respiratory complications (P=0.026) were independent predictive factors.

CONCLUSION

This study suggests that patients > 65-year old were at increased risk of postoperative complications when submitted to isolated on-pump CABG in comparison to patients < 65-year-old, but not under increased risk of death.

摘要

目的

分析年龄大于65岁患者的单纯体外循环冠状动脉旁路移植术(CABG)的结果。

方法

将2010年12月1日至2012年7月31日接受单纯体外循环CABG的患者分为两组:GE组(老年患者,年龄大于65岁,n = 103)和GA组(成年患者,年龄小于65岁,n = 150)。在住院期间分析术前数据、术中数据(如体外循环时间、主动脉阻断时间、机械通气时间和移植血管数量)以及术后变量(如发病率、死亡率和住院时间)。

结果

GE组的发病率高于GA组(30%对14%,P = 0.004),但死亡率无差异(5.8%对2.0%,P = 0.165)。GA组中糖尿病患病率较高(39.6%对27%,P = 0.043)和吸烟率较高(32.2%对19.8%,P = 0.042);而GE组中中风患病率较高(17%对6.7%,P = 0.013)。两组术中变量无差异。多因素分析后,年龄大于65岁与更高的发病率相关,但不是院内死亡的独立预测因素。考虑院内死亡率,病房停留时间(P = 0.006)、心脏(P = 0.011)和呼吸并发症(P = 0.026)是独立预测因素。

结论

本研究表明,与年龄小于65岁的患者相比,年龄大于65岁的患者接受单纯体外循环CABG术后并发症风险增加,但死亡风险未增加。

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