Ott R A, Gutfinger D E, Miller M, Alimadadian H, Codini M, Selvan A, Moscoso R, Tanner T
Division of Cardiothoracic Surgery, University of California Irvine Medical Center, Orange, USA.
J Card Surg. 1997 Sep-Oct;12(5):309-13. doi: 10.1111/j.1540-8191.1997.tb00144.x.
Rapid recovery protocols for coronary artery bypass grafting (CABG) have resulted in major decreases in postoperative hospital length of stay (LOS) when applied to younger patients undergoing elective procedures. However, the effectiveness of rapid recovery protocols when applied to octogenarians has not been thoroughly studied.
Thirty-seven consecutive octogenarians underwent isolated CABG utilizing cardiopulmonary bypass (CPB). A protocol emphasizing preoperative placement of the intra-aortic balloon pump, reduced CPB time, early extubation, perioperative steroids, thyroid hormone, and aggressive postoperative diuresis was used.
The 30-day operative mortality for the entire series was 5.4%. Twenty-five patients (71%, group I) were discharged in < 10 days postoperatively (average LOS of 6.3 +/- 1.6 days), while ten patients (29%, group II) were discharged at 10 or more days postoperatively (average LOS of 20.3 +/- 8.0, p < 0.001). Patients in group II were found to have a higher incidence of obesity (50% vs 4%, p < 0.01), symptomatic peripheral vascular disease (60% vs 8%, p < 0.01), and preoperative ambulatory difficulties (50% vs 0%, p < 0.01). The incidence of complications was 31% for the entire series, with no differences between the groups.
Octogenarians performed well under a rapid recovery protocol, with 71% being discharged in < 10 days postoperatively, while patients with obesity, symptomatic peripheral vascular disease, and ambulatory difficulties rehabilitated more slowly.
冠状动脉旁路移植术（CABG）的快速康复方案应用于接受择期手术的年轻患者时，已使术后住院时间（LOS）大幅缩短。然而，快速康复方案应用于八旬老人时的有效性尚未得到充分研究。
37例连续的八旬老人接受了体外循环（CPB）下的单纯CABG手术。采用了一项强调术前放置主动脉内球囊泵、缩短CPB时间、早期拔管、围手术期使用类固醇、甲状腺激素以及积极的术后利尿的方案。
整个系列的30天手术死亡率为5.4%。25例患者（71%，I组）术后<10天出院（平均LOS为6.3±1.6天），而10例患者（29%，II组）术后10天或更长时间出院（平均LOS为20.3±8.0，p<0.001）。发现II组患者肥胖发生率更高（50%对4%，p<0.01）、有症状的外周血管疾病发生率更高（60%对8%，p<0.01）以及术前活动困难发生率更高（50%对0%，p<0.01）。整个系列的并发症发生率为31%，两组之间无差异。
八旬老人在快速康复方案下表现良好，71%的患者术后<10天出院，而肥胖、有症状的外周血管疾病和活动困难的患者康复较慢。
