老年人冠状动脉疾病的外科治疗

徐明　郭子黄　陈鑫　高岩　缪劲　蒋英硕 华老年医学杂志 1999年第2期第18卷 临床研究

　　【摘要】　目的　探讨老年人冠状动脉疾病外科治疗的疗效。　方法　35例老年患者接受了冠状动脉旁路移植术。按NYHA心功能分级，Ⅲ级17例，Ⅳ级18例。其中3支血管病变24例，左主干病变6例；左室射血分数小于50%者25例。　结果　人均移植血管3.1根，无手术死亡。术后所有患者心绞痛均消失，心功能恢复至Ⅰ级者33例，Ⅱ级2例。随访3～64个月，平均37个月，无死亡。　结论　对于老年冠状动脉疾病患者，冠状动脉旁路移植术是一种安全、有效的治疗方法。

　　Surgical treatment of coronary artery disease in elderly patients

　　XU Ming, GUO Zihuang, CHEN Xin, et al.

　　Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006

　　【Abstract】　Objective　To study the efficacy of surgical treatment on coronary artery disease in elderly patients. 　Methods　Thirty-five elderly patients underwent coronary artery bypass grafting. The mean age was 65.4 years. Seventeen patients were in NYHA class Ⅲ,and 18 were in class Ⅳ. There were 24 patients with 3 branch disease and 6 patients with left main stem disease. Preoperative left ventricular ejection fraction in 25 patients was beyond 50%. 　Results　The mean number of grafts was 3.1 per patient. There was no operative death. The patients were all free from angina postoperatively. The heart function improved to class Ⅰ in 33 patients, class Ⅱ in 2 patients. The mean follow up time was 37 (3-64) months without death. 　Conclusions　Coronary artery bypass grafting is a safe and effective method of treatment to elderly patients with coronary artery disease.

　　【Key words】　Coronary artery disease　　Coronary artery bypass

　　冠状动脉旁路移植术治疗冠状动脉疾病，已被确认为是一种缓解症状和延长寿命的有效方法。我院自1992年3月至1997年5月，为35例老年冠状动脉疾病患者行冠状动脉旁路移植术，取得了良好的临床效果，现报道如下。

　　临床资料

　　一、一般资料

　　35例中，男31例，女4例；年龄60～74岁，平均65.4岁，70岁以上者8例。稳定型心绞痛13例，不稳定型22例。按NYHA心功能分级，Ⅲ级17例，Ⅳ级18例。35例中，至少有1次陈旧性心肌梗死者23例，2次5例，4次1例。3例有充血性心力衰竭，需药物控制。术前并存高血压24例，糖尿病7例，肾功能不全5例，慢性阻塞性肺疾病及慢性消化道疾病各4例，严重心律失常及重度贫血各3例(其中1例已植入永久性起搏器)，脑梗死2例。

　　35例入院后均行冠状动脉造影、左室造影和乳内动脉造影。冠状动脉造影显示单支病变2例，双支病变9例，3支病变24例。冠状动脉病变累及左主干6例，左前降支34例，对角支10例，回旋支6例，钝缘支29例，右冠状动脉32例；狭窄程度为50%～100%。根据左室造影测定的左室射血分数(LVEF)判定左室功能

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