摘要
目的探讨双桡动脉桥(BRA)在冠状动脉旁路移植术(CABG)的中期治疗效果。方法回顾性分析2013年8月至2018年9月我国19家医院运用BRA进行CABG的临床资料,包括围手术期并发症及随访结果。结果共有211例患者(男170例,女41例)运用BRA,年龄41~73(56.5±9.7)岁,冠状动脉三支病变161例,双支病变50例。术前合并糖尿病90例,周围血管病35例,慢性阻塞性肺疾病4例,瓣膜病11例。非体外循环CABG 2例,体外循环CABG 209例,同期瓣膜手术11例。161例运用左胸廓内动脉,全动脉化210例,远端吻合口2~4(2.7±0.9)个。无手术死亡,术后心房颤动12例,前臂血肿1例,胸腔出血7例,低氧血症13例,肺部感染1例。气管插管时间3.5~20.3(8.3±4.7)h,术后住院6~13(7.1±2.9)d。共有191例(90.52%)得到随访,随访时间3~59(35.5±9.3)个月。术后3个月左室射血分数明显增加(61.0%±7.2%比47.1%±5.3%,P=0.017)。1例患者术后14个月死于脑外伤,其余均存活,无重要心血管事件发生。62.6%(132例)的患者在术后(21.5±6.4)个月经冠状动脉CT血管造影(CTA)证实BRA通畅。术后1年与3年累积生存率分别为100%与99.53%。结论BRA在CABG术围手术期安全、并发症少,易于全动脉化而且中期效果优越。
Objective To evaluate the mid-term outcomes of bilateral radial artery (BRA) grafts in coronary artery bypass grafting (CABG). Methods All perioperative medical records and follow-up results of CABG with BRA grafts in multi-centers of China were analyzed retrospectively. ResultsA total of 211 patients (170 males and 41 females) underwent CABG grafting with BRA conduits between August 2013 and September 2018, with a mean age of (56.5±9.7) years old (rang 41 to 73 years). There were 161 cases of triple-vessel disease and 50 cases of two-vessel disease. Ninety patients had diabetes mellitus (DM), 35 patients with peripheral vascular disease, 4 patients with chronic obstructive pulmonary disease and 11 with heart valve disease. Two patients underwent off-pump CABG and 209 patients accepted on-pump CABG with commitment valve surgery. There were 210 cases of total arterial revascularization and 161 cases using left thoracic artery conduits, with a graft number of 2-4 (2.7±0.9). No operation-related death occurred, atrial fibrillation happened in 12 patients, hemothorax in 7 cases, and forearm hematoma in one case, hypoxemia in 13 cases and pneumonia in one case. The duration of mechanical ventilation was (8.3±4.7) hours and the mean hospital length of stay was (7.1±2.9) days. Follow-up was completed in 191 patients (90.52%) with a duration of 3-59 (35.5±9.3) months. The mean left ventricular ejection fraction at 3 months after operation was significantly improved, compared to that of the pre-operation (61.0%±7.2% vs 47.1%±5.3%, P=0.017). All patients survived, except that one died from brain injury. No major cardiac events occurred, with a cumulative survival rate of 100% at 1 year and 99.53% at 3 year after operation, respectively. It was showed in coronary CT angiography (CTA) examination that all grafts in 132 patients were patent at the mean follow-up duration of (21.5±6.4) months. Conclusions BRA grafts as arterial conduit in CABG are proved to be safe, easy for total arterial revascularization and have go
作者
陈绪军
郑宝石
张永
乔晨晖
曹勇
柳德斌
魏翔
凌云鹏
李伟栋
黄克力
武忠
余成
周继梧
郭海平
胡明松
郭能瑞
杨文凯
陆辉辉
孟自力
Chen Xujun;Zheng Baoshi;Zhang Yong;Qiao Chenhui;Cao Yong;Liu Debin;Wei Xiang;Ling Yunpeng;Li Weidong;Huang Keli;Wu Zhong;Yu Cheng;Zhou Jiwu;Guo Haiping;Hu Mingsong;Guo Nengrui;Yang Wenkai;Lu Huihui;Meng Zili(Department of Cardiac Surgery, Wuhan First Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022,China;Department of Cardiac Surgery, Sichuan Provincial People's Hospital, Chengdu 610072,China;Department of Cardiovascular Surgery, West China Hospital, Sichuan University,Chengdu 610041,China;Department of Cardiovascular Surgery, Hainan General Hospital, Haikou 570311,China;Department of Cardiothoracic Surgery,Cangzhou Central Hospital, Cangzhou 061001,China;Department of Cardiac Surgery, Handan First Hospital, Handan 056002,China;Department of Cardiothoracic Surgery, Second. Hospital, University of South China, Hengyang 421001,China;Department of Cardiac Surgery, Yuncheng First Hospital, Yuncheng 044000,China;Department of Cardiothoracic Surgery, Ganzhou Hospital of Jiangxi Province,Ganzhou 341000,China;Department of Cardiothoracic Surgery, Hunan Provincial Hospital of Traditional Medicine,Zhuzhou 412000,China;Department of Cardiac Surgery, Hebei Chest Hospital,Shijiazhuang 050041,China;Department of Cardiac Surgery,the First Affiliated Hospital of Guangxi Medical University, Nanning 530021,China;Department of Cardiac Surgery, Beijing Friendship Hospital, Capital Medical University,Beijing 100059,China;Department of Cardiac Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052,China;Department of Cardiovascular Surgery, Gaozhou People's Hospital, Gaozhou 525200,China;Department of Cardiac Surgery, Second Hospital of Lanzhou University, Lanzhou 730030,China;Department of Cardiovascular Surgery, Tongji Medical School of Huazhong University of Science and Technology,Wuhan 430022,China;Department of Cardiac Surgery, Peking University Third Hospital, Beijing 100191,China;Department of Cardiothoracic Surgery, First Affiliated Hospital, Zhejiang Universit
出处
《中华医学杂志》
CAS
CSCD
北大核心
2019年第14期1069-1074,共6页
National Medical Journal of China
