Ott R A, Gutfinger D E, Miller M P, Alimadadian H, Tanner T M
Division of Cardiothoracic Surgery, University of California Irvine Medical Center, Orange, California 92668, USA.
Ann Thorac Surg. 1997 Mar;63(3):634-9. doi: 10.1016/s0003-4975(96)01098-3.
Rapid recovery protocols after coronary artery bypass grafting have been applied successfully to young patients with normal ventricular function. However, the success of such protocols when applied to the elderly population has not been thoroughly validated, and at some centers there is still reluctance in allowing elderly patients to be discharged early from the hospital.
One hundred fifty-two consecutive younger patients (< 70 years) were compared retrospectively with 167 consecutive elderly patients (> or = 70 years) who underwent isolated coronary artery bypass grafting using cardiopulmonary bypass. A rapid recovery protocol emphasizing an anesthetic protocol for early extubation, reduced cardiopulmonary bypass time, and perioperative administration of corticosteroids and thyroid hormone was applied to all patients. The protocol also emphasized early identification and management of postoperative atrial fibrillation, a proactive negative fluid balance, rapid return of bowel function, mobilization of the patient, and aggressive use of the intraaortic balloon pump preoperatively.
The 30-day mortality rate for the younger group of patients was 3.3% (Parsonnet risk 7.2 +/- 6.2), compared with 4.2% (Parsonnet risk, 17.7 +/- 6.8) for the elderly group of patients. There were no statistically significant differences in the 30-day mortality rates or postoperative complications between the elderly and younger patient groups. Rapid recovery with discharge before the fifth postoperative day was achieved in 19% of the elderly, in comparison with 48% of the younger patients (p < 0.001). The younger patients were discharged earlier after operation than the older patients (5.7 +/- 5.2 versus 8.0 +/- 8.5 days; p < 0.01).
Application of the rapid recovery protocol helped expedite recovery for all patients regardless of age, acuity of illness, or associated conditions. Although younger patients had a significantly shorter postoperative length of hospital stay, older patients performed well and are suitable candidates for rapid recovery protocols.
冠状动脉搭桥术后的快速康复方案已成功应用于心室功能正常的年轻患者。然而，将此类方案应用于老年人群的效果尚未得到充分验证，在一些中心，对于允许老年患者早期出院仍存在顾虑。
回顾性比较152例连续的年轻患者（<70岁）与167例连续的老年患者（≥70岁），这些患者均接受了体外循环下的单纯冠状动脉搭桥手术。所有患者均采用了一种快速康复方案，该方案强调用于早期拔管的麻醉方案、缩短体外循环时间以及围手术期使用皮质类固醇和甲状腺激素。该方案还强调术后房颤的早期识别和处理、积极的负液体平衡、肠道功能的快速恢复、患者的活动以及术前积极使用主动脉内球囊泵。
年轻患者组的30天死亡率为3.3%（Parsonnet风险7.2±6.2），而老年患者组为4.2%（Parsonnet风险，17.7±6.8）。老年和年轻患者组之间的30天死亡率或术后并发症无统计学显著差异。19%的老年患者在术后第5天前实现了快速康复并出院，相比之下，年轻患者为48%（p<0.001）。年轻患者术后出院时间早于老年患者（5.7±5.2天对8.0±8.5天；p<0.01）。
快速康复方案的应用有助于所有患者加快康复，无论其年龄、疾病严重程度或相关病情如何。尽管年轻患者术后住院时间明显较短，但老年患者恢复良好，适合采用快速康复方案。
