Ranger W R, Glover J L, Shannon F L, Sakwa M P, Bassett J S
William Beaumont Hospital, Royal Oak, Michigan, USA.
Am Surg. 1996 Nov;62(11):941-6.
A total of 325 patients, aged 80 to 92 (mean 82), underwent cardiac operations with cardiopulmonary bypass over a 4-year period (1991-1995). Hypothermia (22 degrees C) and hyperkalemic cardioplegia were used in each. Coronary bypass procedures only (Group I) were performed in 255 patients with 22 early deaths (8.6%), and the average number of grafts was 3.7 per patient. Single or double valve replacement, with coronary bypass (Group II) was performed in 46 patients, with six early deaths (13%). Single or double valve replacement, without coronary bypass (Group III) was performed in 24 patients, with two early deaths (8.3%). Total hospital mortality was 30 deaths in 325 patients (9.2%). Fifty-six procedures (22%) from Group I and four (9%) from Group II were performed as emergencies, and all operations in Group III were elective. Seventy-two patients (27%) from Group I, 18 patients (39%) from Group II, and nine patients (37%) from Group III had major complications including renal failure, cerebrovascular accident, myocardial infarction, postoperative hemorrhage, sepsis, and ventilatory dependency. Mean hospital stay was 10.5 days for Group I, 13.3 days for Group II, and 15.2 days for Group III, with an overall mean of 13 days (range, 6-52) days. Higher mortality was related to a cardiac index <1.8, cardiogenic shock, emergency operation, creatinine >2.0, and morbid obesity. Mean left ventricular ejection fractions were 0.51 for Group I, 0.45 for Group II, and 0.49 for Group III. Preoperative risk factors associated with a higher mortality included hypertension, smoking, diabetes, and pulmonary hypertension. Two hundred seventy-two of the 299 operative survivors were followed for a mean of 18 (range, 3-52) months. The actuarial survival of octogenarians is 92 per cent, 80 per cent, and 65 per cent at 1, 3, and 5 years, respectively, and of the patients surviving operation it was 85 per cent, 70 per cent, and 55 per cent at 1, 3, and 5 years, respectively. At postoperative follow up, 80 per cent of the survivors reported an active functional status, and there was a low incidence of cardiac-related deaths.
在4年期间（1991 - 1995年），共有325例年龄在80至92岁（平均82岁）的患者接受了体外循环心脏手术。每例患者均采用低温（22摄氏度）和高钾停搏液。仅行冠状动脉搭桥手术（第一组）的患者有255例，早期死亡22例（8.6%），每位患者平均搭桥数量为3.7根。46例患者接受了单瓣膜或双瓣膜置换术并同期行冠状动脉搭桥手术（第二组），早期死亡6例（13%）。24例患者接受了单瓣膜或双瓣膜置换术但未行冠状动脉搭桥手术（第三组），早期死亡2例（8.3%）。325例患者中共有30例住院期间死亡（9.2%）。第一组中有56例手术（22%）、第二组中有4例手术（9%）为急诊手术，第三组所有手术均为择期手术。第一组中有72例患者（27%）、第二组中有18例患者（39%）、第三组中有9例患者（37%）出现了包括肾衰竭、脑血管意外、心肌梗死、术后出血、败血症和呼吸依赖等严重并发症。第一组患者平均住院时间为10.5天，第二组为13.3天，第三组为15.2天，总体平均住院时间为13天（范围6 - 52天）。较高的死亡率与心脏指数<1.8、心源性休克、急诊手术、肌酐>2.0以及病态肥胖有关。第一组患者平均左心室射血分数为0.51，第二组为0.45，第三组为0.49。与较高死亡率相关的术前危险因素包括高血压、吸烟、糖尿病和肺动脉高压。299例手术存活患者中的272例接受了平均18个月（范围3 - 52个月）的随访。80岁以上老人1年、3年和5年的预期生存率分别为92%、80%和65%，手术存活患者1年、3年和5年的预期生存率分别为85%、70%和55%。术后随访时，80%的存活患者报告功能状态良好，心脏相关死亡发生率较低。
