者，应结合X线胸片、红细胞压积、中心静脉压及血压综合判断。对于老年患者，开胸探查应及时，指征可适当放宽，可防止老年患者病情急剧变化，不增加并发症及术后死亡。细致的止血、避免手术探查，对老年患者手术成功相当关键。 动脉旁路的远期通畅率高于静脉旁路，是提高手术远期疗效的关键〔6〕。静脉旁路远期通畅率低为其缺点，但对于老年人，由于其术后自然寿命短，因而影响不大。由于乳内动脉的游离和吻合难度相对较大，导致手术时间延长和创面渗血，刚开展手术时不宜采用。我们主张：对于60～70岁的老年患者，应选择乳内动脉与前降支吻合；对于70岁以上的老年患者，可完全用静脉作旁路移植。
参考文献
1 Keith AH, Verdi JD, Pamela SP, et al. Favorable results of CABG in patients older than 75 years. J Thorac Cardiovasc Surg, 1990,99:92-96.
2 He GW, Acutt TE. Determinants of operative mortality in elderly patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg, 1994,108:76-80.
3 Lynda LM, Paul MW, Yasuchi T, et al. Risk factors for stroke in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg, 1996, 112:1250-1259.
4 Chan RK. Prediction of outcome after revascularization in patients with poor left ventricular function. Ann Thorac Surg, 1996,61:1428-1434.
5 Michael JW, Lawrence LC, Mary EM, et al. Reexploration for bleeding is a risk factor for adverse outcome after cardiac operation. J Thorac Cardiovasc Surg, 1996,111:1037-1046.
6 Nottin R, Grinda JM, Anidjar S, et al. Coronary-coronary bypass graft: an arterial conduct sparing procedure. J Thorac Cardiovasc Surg, 1996,112:1223.
上一页 [1] [2] [3]
您现在的位置： 绿色健康网 >> 医学论文 >> 内科论文 >> 正文