摘要
目的分析冠状动脉(冠脉)旁路移植术(CABG)后再发心绞痛的原因及进行介入治疗的有效性和安全性。方法再发缺血症状的 CABG 术后老年患者78例.进行冠脉和桥血管造影,并同时对53例进行介入治疗。结果 78例均进行冠脉和桥血管造影,其中8例桥血管通畅,原冠脉病变无或有轻微发展;17例桥血管严重狭窄或全部闭塞,同时,原冠脉3支弥漫严重病变;53例原冠脉血管病变有明显进展或桥血管出现严重病变或闭塞。78例共移植桥血管226支(其中大隐静脉桥血管153支,乳内动脉桥69支,桡动脉桥4支)。大隐静脉桥血管1 53支中,110支发生病变(71.9%,其中长段弥漫性病变或完全闭塞77支,吻合口狭窄14支,体部狭窄1 9支)。乳内动脉桥共69支,27支发生病变,占39.1%(其中全程弥漫性病变和完全闭塞12支,吻合口狭窄15支)。桡动脉桥共4支,通畅3支,吻合口狭窄1支。226支桥血管发生病变共有138支(包括大隐静脉桥血管110支,乳内动脉桥27支,桡动脉桥1支),桥血管吻合口狭窄30支,体部病变19支,弥漫病变或完全闭塞89支。在吻合口狭窄的桥血管中,术后0～3个月发生21支(70.0%),术后3～12个月发生9支(30.0%),术后1年以上无吻合口狭窄。在体部病变的桥血管中术后0～3个月未发生病变,术后3～12个月发生10支(52.6%),术后1年以上发生9支(47.7%)。桥血管弥漫病变或完全闭塞术后0～3个月发生28支(31.5%),术后3～12个月发生14支(15.7%),术后1年以上发生47支(52.8%)。53例患者进行原发血管和(或)桥血管介入治疗,50例介入治疗成功(94.3%)。所有病变介入治疗后均即刻获得良好结果,30d随访,未出现严重心脏事件。结论 CABG 术后再发心绞痛介入治疗成功率、有效性、安全性均较高,介入治疗可作为 CABG 术后再发缺血的主要治疗手段之一。
Objective To analyze the cause of angina recurrence after coronary artery bypass graft （CABG）, the effectiveness and security of the interventional therapy. Methods Seventy-eight patients had clinical ischemia symptoms after CABG and underwent coronary artery and bridge vessel angiography. Among them, 53 patients received further interventional therapy. Results Among the 78 cases, 8 patients showed no bridged vessels obstruction, and no or little pathological developnent in coronary arteries. Seventeen cases had severe stenosis or total obstruction in bridged vessels, with multi-stenosis of originally diseased coronary artery. Fifty-three cases had obvious advancement in coronary artery lesion, and severe stenosis or total obstruction of bridged vessel. Seventy-eight patients had 226 bridged vessels, including 153 great saphenous veins, 69 internal mammary arteries, 4 radial arteries. There were 110（71.9%） great saphenous vein lesions, including 77 diffuse lesion or total obstruction, 14 stoma stenosis, 19 caudomedial part stenosis. Among 69 internal mammary artery bridge, there were 27 （39.1%）bridged vessel lesions, including 12 diffuse lesion or obstruction, 15 stoma stenosis. There were 4 radial artery bridged vessels： 3 without obstruction, 1 with stoma stenosis. There were 138 vessel lesions in 226 bridged vessels, including 110 great saphenous veins, 27 internai mammary arteries, 1 radial arteries. The 138 bridged vessel lessions included 30 stoma stenosis, 19 caudomedial part stenosis, 89 diffuse lesion or obstruction. There were 21 （70, 0%） stoma stenosis emerging after 0-3 months, 9 （30.0 %） stoma stenosis after 3 12 months. There were 10 （52.6%） caudomedial part stenosis emerging after 3-12 months, 9 （47.4%）caudomedial part stenosis after 1 year. There were 28 （31.5%）diffuse lesions or obstruction of bridged vessels occurring after 0-3 months, 14 （15.7 % ）diffuse lesions or obstruction after 3-12 months, 47 （52.8 %） diffuse lesions or obstruction after 1 y
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2006年第5期336-338,共3页
Chinese Journal of Geriatrics
关键词
冠状动脉分流术
体外循环
心绞痛
冠状动脉造影术
Coronary artery bypass
Extracorporeal circulation
Angina pectoris
Coronary angiography
