摘要
目的总结冠状动脉旁路移植术（CABG）后旁路血管造影特点，分析相关因素对旁路血管通畅率的影响，并探讨提高旁路血管通畅率的方法。方法2004年4月至2006年4月间CABG术后平均间隔（46.4±39.1）个月，因心绞痛复发再入院行冠状动脉造影（CAG）病人149例，男120例；平均年龄（61.0±10.1）岁。共444支旁路血管，其中左乳内动脉（LIMA）131支，大隐静脉（SV）295支，左桡动脉（RA）15支，右乳内动脉（RIMA）3支。旁路血管造影完全闭塞或狭窄≥75%视为旁路血管病变。结果本组65.1%（97/149例）病人有旁路血管病变。31.1%（138/444支）旁路血管发生病变。LIMA闭塞5.3%（7/131支），狭窄（≥75%）6.9%（9/131支）；SV旁路血管闭塞31.9%（94/295支），狭窄7.5%（22/295支）；RA旁路血管闭塞33.3%（5/15支）；RIMA旁路血管闭塞33.3%（1/3支）。LIMA旁路血管的通畅率明显优于SV。不同靶血管的SV旁路血管通畅率有明显差别。吻合口以远冠状动脉口径（runoff）≥2.0 mm的旁路血管通畅率明显高于〈2.0mm者，尤其是SV旁路血管。近端冠状动脉狭窄程度对LIMA-前降支的通畅率影响明显，而对主动脉-SV-后降支通畅率影响不明显。序贯吻合及非体外循环CABG对旁路血管通畅率无明显影响。结论CABG术后旁路血管病变比较常见，是造成术后心绞痛复发的重要原因。不同旁路血管、不同靶血管、runoff大小、近端冠状动脉狭窄程度均明显影响旁路血管通畅率。手术技术不当是术后早期旁路血管病变的主要原因。改进手术技术，术后早期足量抗血小板药物及强化降脂治疗是提高旁路血管通畅率的关键。
Objective To summarize the angiographic characteristic of graft in patients with recurrence of angina after coronary artery bypass grafting（CAABG）and define the preoperative and intraoperative factors that affect graft patency.To discuss the strategy to improve the graft patency.Methods From April 2004 to April 2006,149 patients who had primary CABG in our hospital under- went coronary arteriography（CAG）for recurrence of angina.The preoperative patient characteristics and intraoperative variables were retrospectivel collected. A total of 120 （80%） patients were male, with a mean age of 61 years. The interval from CABG to CAG was （46.4 ± 39.1 ） months （from 1 day to 161 months）. 444 gratis were studied, including 131 left internal mammary artery （LIMA） grafts, 295 saphenous vein grafts （SVGs）, 15 radial artery （RA） grafts and 3 right internal mammary （RIMA） grafts, Graft failure was defined as 75% stenosis or more or completely occluded. Results During the course of the study, the graft failure was found in 65.1% （97/149） of the patients. 31.1% （138/444） of the gratis had failed. Total occlusion was found in5. 3%（7/131） of the LlaMA grafts and ≥75% stenosis in 6.9% （9/131）. SVCO total occlusion was 31.9% （94/295）, 375% stenosis was 7.5% （22/295）. Total occlusion was found in 33.3% of the RA and RIMA gratis. The patency of LIMA gratis was significantly better than that of SVCO. The degree of procimal coronary stonosis was a major predictor of LIMA grafts patoncy. As preoperative proximal coronary stenosis decreased, LIMA patency declined. Target coronary artery was associated with patency of SVCO with maximum patency when grafted to the left anterior descending artery （LAD） and the worst patency to the right coronary artery. Recipient artery diameter was another predictor of graft patency, especially for SVCO. In vessels ≥2.0 mm in diameter graft patency was significantly higher than that in vessels 〈 2.0 mm. Single versus sequential SVCO and on
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2007年第6期382-385,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
