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非体外循环冠状动脉旁路移植术后血运重建不完全对八旬老人围手术期结局的影响

[Impacts of incomplete revascularization following off-pump coronary artery bypass grafting on perioperative outcomes in octogenarians].

作者信息

Peng Z, Hua K, Zhang L, Mao B, Zhou Y, Zhang J W, Yang X B

机构信息

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing 100029, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2020 Nov 3;100(40):3152-3156. doi: 10.3760/cma.j.cn112137-20200406-01091.

Abstract

To assess the impacts of incomplete revascularization following off-pump coronary artery bypass grafting (OPCABG) on perioperative outcomes in octogenarians. A retrospective analysis of 242 octogenarian patients with coronary artery disease (CAD) hospitalized in Beijing Anzhen Hospital from June 2008 to July 2016 was performed. These patients were divided into the complete revascularization group (181) and the incomplete revascularization group (61) depending on whether they underwent complete revascularization. The impacts of incomplete revascularization following OPCABG on perioperative outcomes were summarized and compared between the two groups. Among the 242 patients over 80 years who received OPCABG, there were 198 males (81.8%). Compared to the complete revascularization group, those in the incomplete revascularization group were older [(83.2±1.5) vs (81.5±1.1) years old, 0.03], with more carotid stenosis (44.3% vs 25.4%, 0.01), more involved in the diagonal and circumflex branch of coronary artery (49.2% vs 17.1%, 0.01; 83.6% vs 70.2%, 0.03), shorter operative time [(4.1±1.7) h vs (4.7±1.2) h, 0.03), longer preoperative [(7.1±2.3) d vs (5.2±2.0) d, 0.01] and total hospitalization time [(16.3±6.8) d vs (12.5±4.2) d, 0.01], however, the differences of the in-hospital mortality and incidence of other perioperative complications were not statistically significant between the two groups (all 0.05). Compared with complete revascularization, incomplete revascularization following OPCABG in CAD patients over 80 years old does not increase the perioperative mortality and the incidence of other complications, and it reduces the operative time. However, it increases the time of preoperative and total hospital stay.

摘要

评估非体外循环冠状动脉旁路移植术(OPCABG)后血管重建不完全对八旬老人围手术期结局的影响。对2008年6月至2016年7月在北京安贞医院住院的242例患有冠状动脉疾病(CAD)的八旬老人进行回顾性分析。根据这些患者是否接受完全血管重建,将他们分为完全血管重建组(181例)和不完全血管重建组(61例)。总结并比较了OPCABG后血管重建不完全对围手术期结局的影响,并在两组之间进行了比较。在接受OPCABG的242例80岁以上患者中,有198例男性(81.8%)。与完全血管重建组相比,不完全血管重建组患者年龄更大[(83.2±1.5)岁对(81.5±1.1)岁,P=0.03],颈动脉狭窄更多(44.3%对25.4%,P=0.01),冠状动脉对角支和回旋支受累更多(49.2%对17.1%,P=0.01;83.6%对70.2%,P=0.03),手术时间更短[(4.1±1.7)小时对(4.7±1.2)小时,P=0.03],术前住院时间[(7.1±2.3)天对(5.2±2.0)天,P=0.01]和总住院时间更长[(16.3±6.8)天对(12.5±4.2)天,P=0.01],然而,两组之间的院内死亡率和其他围手术期并发症的发生率差异无统计学意义(均P>0.05)。与完全血管重建相比,80岁以上CAD患者OPCABG后血管重建不完全不会增加围手术期死亡率和其他并发症的发生率,并且会缩短手术时间。然而,它会增加术前和总住院时间。

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