Hamanaka S, Hata T, Tsushima Y, Matsumoto M, Yoshitaka H, Fujiwara K, Sodenaga Y, Masuda Z, Minami H
Department of Cardiovascular Surgery, Cardiovascular Center Sakakibara Hospital, Okayama, Japan.
Kyobu Geka. 1997 Jul;50(8 Suppl):660-3.
Coronary artery bypass grafting (CABG) has been performed for elderly patients with increasing frequency. Several studies have shown that the rate of complications and mortality in elderly patients are higher than in younger ones. This report presents results of CABG in patients over 75 years old. From January 1989 to February 1997, 604 patients underwent CABG, of whom 20 patients (3.3%) were 80-86 years old (group A) and 57 patients (9.4%) were 75-79 years old (group B). We compared these two groups with 100 younger patients (group C). Preoperative use of intraaortic balloon pumping and the emergency operation were more frequent in patients of group A (emergency 45%, IABP 20%). And the proportion of the no blood transfusion procedures was lower in elderly patients (group A 20%, group B 18%, group C 82%). The number of grafts per patient (group A 2.45 +/- 0.62, group B 2.2 +/- 0.6, group C 3.2 +/- 0.6) and the number of arterial grafts (group A 1.25 +/- 0.62, group B 1.25 +/- 0.66, group C 2.1 +/- 0.53) were different between the groups. But CABG in elderly patients was performed with low hospital mortality (group A 0%, group B 0.18%) and significant symptomatic benefit. We conclude that CABG can be performed in elderly patients with acceptable mortality and acceptable quality of life, so patients should not denied operation because of an advanced age.
冠状动脉旁路移植术（CABG）在老年患者中的实施频率日益增加。多项研究表明，老年患者的并发症发生率和死亡率高于年轻患者。本报告呈现了75岁以上患者行CABG的结果。1989年1月至1997年2月，604例患者接受了CABG，其中20例患者（3.3%）年龄在80 - 86岁（A组），57例患者（9.4%）年龄在75 - 79岁（B组）。我们将这两组与100例年轻患者（C组）进行了比较。A组患者术前主动脉内球囊反搏和急诊手术的使用更为频繁（急诊45%，IABP 20%）。老年患者中无输血手术的比例较低（A组20%，B组18%，C组82%）。各组患者的移植血管数量（A组2.45±0.62，B组2.2±0.6，C组3.2±0.6）和动脉移植血管数量（A组1.25±0.62，B组1.25±0.66，C组2.1±0.53）存在差异。但老年患者行CABG的住院死亡率较低（A组0%，B组0.18%），且有显著的症状改善。我们得出结论，CABG可在老年患者中进行，死亡率可接受，生活质量也可接受，因此不应因患者年龄较大而拒绝手术。
