【摘要】 目的 通过对一组高龄冠心病治疗的回顾分析，探讨高龄冠脉搭桥手术适应证与围术期并发症处理，以提高冠心病外科治疗的效果。方法 2002年1月～2005年7月对65岁及以上134例冠心病患者进行外科治疗。左主干严重狭窄26例，3支病变96例，双支病变12例。合并左心室壁瘤2例,左室壁瘤和室间隔穿孔2例。其中单纯冠状动脉旁路移植术(CABG)127例, 冠状动脉旁路移植术(CABG)加室间隔穿孔修补术2例，CABG加室间隔穿孔修补术加瓣膜置换术3例，CABG加室间隔穿孔修补术加室壁瘤成形术2例。仅10例在CPB心脏停跳下完成，其余均采用OPCABG技术。结果 死亡3例，死亡率2.22%,术后低心排4例。心绞痛症状完全消失91例，减轻4例。结论 正确掌握CABG的手术适应证,合理选择冠脉搭桥材料,以及加强围术期并发症的处理是提高冠心病外科治疗效果的重要措施。

    【关键词】 冠心病;外科治疗;冠状动脉旁路移植术

    Analysis in 134 patients over 65 ages treated with coronary artery by pass procedeure

    DUAN Yu-yin,ZHANG Gui-min,LIU Yi-ping,et al.

    Department of Cardiac Surgery,The First Affiliated Hospital of Kunming Medical College,Yunnan 650031,China

    【Abstract】 Objective To promote the efficacy of surgical treatment of coronary artery disease (CAD) by analyzing 134 older patients and probing indications and complications.Methods 134 patients with CAD underwent surgical procedures including coronary artery bypass graft (CABG) in 127. The lesions involved were ：left main trunk in 26,all three branches in 58,double branches in 12.CAD plus left ventricular aneurysm in 2,left ventricular aneurysm plus perforation of ventricular septum in 2.CABG in 127,CABG plus ventricular septal repair in 2,CABG plus ventricular septal repair and valve replace ment in 3,CABG plus ventricular septal repair and left ventricular reconstruction in 2. Coronary artery bypass in 10, off-pump coronary artery bypass(OPCAB) in others.Results Three cases died. Mortality is 2.22%.Low cardiac output after operation in 4.91 cases get rid of angina completely,and relieve in 4.Conclusion Correct handling of indications for CABG,rational selection of bypass surgery materials and appropriate management of complications during perioperative period were important measures leading to successful treatment of CAD. ......