摘要
目的分析冠状动脉搭桥术（CABG）后桥血管病变特点并探讨不同手术策略对桥血管病变的影响。方法收集我院CABG术后因再发心肌缺血于2014年10月至2016年10月再次入院行冠状动脉造影（CAG）共126例患者的临床资料，其中桥血管病变（桥血管造影显示狭窄≥75％或出现“线样征”）80例，自体冠状动脉病变加重（未搭桥冠状动脉狭窄从〈75％加重到≥75％）46例。对80例桥血管病变患者的259支桥血管及其吻合口进行评估，单支桥140支，序贯桥119支，平均3．2支／人，其中左乳内动脉桥72支、左桡动脉桥8支、右桡动脉桥3支、大隐静脉桥176支。结果①桥血管病变患者80例，构成比63．5％；自体冠状动脉病变加重患者46例，构成比36．5％。②靶血管直径≥1.5mm和直径〈1．5mm的桥血管病变率分别为22．9％和42．9％，差异有统计学意义（P〈O．05）。③单支桥、序贯桥病变率分别为25．0％、28．6％，差异无统计学意义（P〉0．05）。结论桥血管病变是CABG术后患者再发心肌缺血的主要原因。术中尽可能选择直径1．5mm以上的靶血管吻合，采用序贯吻合技术不增加桥血管病变率。
Objective To analyze the characteristics of bypass conduits and to investigate the influence of different surgical strategies on bypass conduits lesions of postoperation. Methods The clinical data of 126 postop- erative patients with recurrent myocardial ischemia and underwent coronary angiography in our hospital from Octo- ber 2014 to October 2016 were collected. The bypass conduits （angiography showed stenosis 75% or a ＂line like sign＂） in 80 cases and aggravation of native coronary artery lesions （not bypass coronary artery stenosis from less than 75% increased to more than 75% ） in 46 cases. 259 vessels and anastomosis in patients with vascular disease in 80 cases were evaluated, including 140 single-bridge and 119 sequential-bridge. An average of 3.2 bridge ves- sels per patient, which include 72 left internal mammary arteries, 8 left radial arteries, 3 right radial arteries and 176 great saphenous vein bridge. Results （1）80 cases were the lesion of the bypass conduits, the constituent ratio was 63.5%, and the severity of coronary artery lesion was aggravate in 46 cases, the constituent ratio was 36.5%. （2）The target vessel diameter over 1.5 mm and diameter less than 1.5 mm graft disease rates were 22.9% and 42.9%, the difference was statistically significant （P〈0.05）. （3）Single-bridge and sequential-bridge lesions rates were 25% and 28.6%, the difference was not statistically significant （P〉0.05）. Conclusion The bypass conduits lesion was the main cause of recurrent myocardial ischemia of patients underwent CABG, as far as possible to choose the target vessel diameter anastomosis above 1.5 mm and the sequential anastomosis did not increase the rate of bypass conduits lesions.
出处
《中国心血管病研究》
CAS
2017年第11期981-984,共4页
Chinese Journal of Cardiovascular Research
基金
国家临床重点专科建设项目（2011）
河南省科技发展计划项目（项目编号：132102310190）
关键词
冠状动脉搭桥术后
桥血管造影
靶血管直径
序贯吻合技术
Coronary artery bypass grafting
Bridge angiography
Target vessel diameter
Se-quential anastomosis technique
