Lee J H, Graber R, Popple C G, Furey E, Lyons T, Murrell H K, Geha A S
Division of Cardiothoracic Surgery and Anesthesia, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, OH 44106, USA.
J Cardiothorac Vasc Anesth. 1998 Aug;12(4):381-4. doi: 10.1016/s1053-0770(98)90187-2.
Early extubation and fast-track management protocols on younger, low-risk patients result in shorter hospital stays and decreased costs. The impact of such protocols on elderly patients undergoing coronary artery bypass graft (CABG) surgery is not presently known.
A matched retrospective cohort study.
A university teaching hospital.
Six hundred ninety-eight consecutive patients undergoing isolated CABG between January 1995 and September 1996.
Three hundred seventy-seven patients underwent early extubation, defined as extubation within 8 hours of arrival in the intensive care unit. They were divided into groups of patients 70 years of age and younger (n = 263) and patients older than 70 years of age (n = 114).
The mean length of stay (LOS) for all patients extubated within 8 hours or less was 5.5 days versus 8.4 days for patients who underwent later extubation (p < 0.0001). The percentage of patients undergoing early extubation was greater for the younger cohort (59% v 48%; p < 0.003) compared with the older cohort of patients. Analysis of demographics showed the older patients to have a greater incidence of peripheral vascular disease, congestive heart failure, and prior strokes (p < 0.05). Although the intensive care unit LOS was similar, postoperative LOS was 5.3 +/- 1.8 days for the younger patients versus 6.1 +/- 2.6 days for the older patients (p = 0.001). The overall surgical mortality rate was 2.6% (18/698), and there were no deaths among patients undergoing early extubation. Reintubation rate was negligible in both groups of patients.
This study confirms the safety and efficacy of early extubation among elderly patients undergoing CABG. Elderly patients have more comorbid conditions, yet a significant number can be extubated early, with resultant shortened LOSs.
针对年轻、低风险患者的早期拔管和快速康复管理方案可缩短住院时间并降低成本。目前尚不清楚此类方案对接受冠状动脉旁路移植术（CABG）的老年患者的影响。
一项匹配的回顾性队列研究。
一家大学教学医院。
1995年1月至1996年9月期间连续698例接受单纯CABG手术的患者。
377例患者接受早期拔管，定义为在进入重症监护病房后8小时内拔管。他们被分为70岁及以下患者组（n = 263）和70岁以上患者组（n = 114）。
所有在8小时或更短时间内拔管的患者平均住院时间（LOS）为5.5天，而延迟拔管的患者为8.4天（p < 0.0001）。与老年患者队列相比，年轻队列中接受早期拔管的患者百分比更高（59%对48%；p < 0.003）。人口统计学分析显示，老年患者外周血管疾病、充血性心力衰竭和既往中风的发生率更高（p < 0.05）。尽管重症监护病房的住院时间相似，但年轻患者的术后住院时间为5.3±1.8天，老年患者为6.1±2.6天（p = 0.001）。总体手术死亡率为2.6%（18/698），早期拔管患者中无死亡病例。两组患者的再插管率均可忽略不计。
本研究证实了CABG老年患者早期拔管的安全性和有效性。老年患者合并症更多，但仍有相当数量的患者可以早期拔管，从而缩短住院时间。
