2019 年第 3 期 第 14 卷

主动脉内球囊反搏在非体外循环冠状动脉旁路移植术老年患者中的应用效果

Application of intra-aortic balloon pump in elderly patients undergoing off-pump coronary artery bypass grafting

作者：王轶芃马骏董然

英文作者：

单位：100029首都医科大学附属北京安贞医院麻醉中心（王轶芃、马骏），心脏外科（董然）

英文单位：

关键词：非体外循环冠状动脉旁路移植术；主动脉内球囊反搏

英文关键词：

• 摘要：

• 【摘要】目的    探讨主动脉内球囊反搏（IABP）在老年非体外循环冠状动脉旁路移植术（OPCABG）患者中的应用效果。方法    回顾性分析2016年7月至2017年6月首都医科大学附属北京安贞医院连续183例应用IABP辅助的OPCABG患者的临床资料。按年龄将患者分为≥70岁组（56例）和＜70岁组（127例）。比较2组患者的一般临床资料、手术情况及术后情况。结果    2组患者在手术时间、冠状动脉旁路移植支数方面差异无统计学意义（P＞0.05）。在乳内动脉应用方面，年龄≥70岁组患者使用率明显低于年龄＜70岁组患者［60.7%（34/56）比84.3%（107/127）］（P＜0.001）。2组在术后低心排出量综合征、急性心肌梗死、急性肾损伤需连续性肾脏替代治疗、IABP侧下肢缺血、输注血制品、新发脑卒中、严重循环衰竭需体外膜肺氧合辅助方面差异均无统计学意义（均P＞0.05）；但年龄≥70岁组新发心房颤动比例明显高于年龄＜70岁组［55.4%（31/56）比27.6%（35/127）］（P＜0.001）。2组在呼吸机辅助时间、住监护室时间及死亡率方面差异无统计学意义（P＞0.05）。结论    IABP在老年OPCABG患者中的应用安全有效。

• 【Abstract】Objective    To observe the effectiveness of intra-aortic balloon pump(IABP) in elderly patients undergoing off-pump coronary artery bypass grafting(OPCABG). Methods    Clinical data of 183 consecutive patients undergoing IABP-assisted OPCABG between July 2016 and June 2017 in Beijing Anzhen Hospital, Capital Medical University were reviewed. The patients were divided into ≥70 years old group（n＝56） and ＜70 years old group（n＝127）. Clinical data, surgical records and postoperative recovery were analyzed. Results    There was no significant difference of operating time and number of bypass arteries between groups（P＞0.05）. Internal thoracic artery was less used in ≥70 years old group compared to that in ＜70 years old group［60.7%（34/56） vs 84.3%（107/127）］（P＜0.001）. No obvious difference in postoperative complications such as low cardiac output syndrome, acute myocardial infarction, acute kidney injury requiring continuous renal replacement therapy, IABP-side lower extremity ischemia, blood transfusion, stroke and extracorporeal membrane oxygenation support for circulatory failure was noticed（all P＞0.05）. Patients in ≥70 years old group showed a higher incidence of newly developed atrial fibrillation than ＜70 years old group［55.4%（31/56） vs 27.6%（35/127）］（P＜0.001）. There was no significant difference of mechanical ventilation time, intensive care unit stay time and mortality between groups（P＞0.05）. Conclusion    IABP is safe and effective in the elderly undergoing OPCABG.