冠状动脉旁路移植术后移植血管狭窄的危险因素分析  

Analysis of the Risk Factors of Graft Stenosis Following Coronary Artery Bypass Grafting

作　　者：陈绪军[1] 陈鑫[1] 石开虎[1] 徐明[1] 汪黎明[1] 

机构地区：[1]南京医科大学附属南京第一医院南京市心血管病研究所胸心血管外科,南京210006

出　　处：《中国胸心血管外科临床杂志》2008年第6期418-422,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨冠状动脉旁路移植术(CABG)后移植血管狭窄的危险因素,为临床CABG术后移植血管狭窄的防治提供依据。方法回顾性分析1999年1月至2007年12月间197例CABG术后行选择性血管造影患者的临床资料,CABG术后按选择性血管造影检查是否有移植血管狭窄,将197例患者分为两组,狭窄组(n=87),非狭窄组(n=110)。采用t检验、χ2检验和多因素logistic回归分析影响移植血管狭窄的危险因素。结果狭窄组的87例患者血管造影显示存在不同程度的移植血管狭窄,累及吻合口321处,其中远端吻合口305处,近端吻合口16处。单因素分析结果表明,合并糖尿病、血脂异常、远端吻合口吻合于右冠状动脉系统、靶血管狭窄<70%、靶血管管径<1.5mm、应用大隐静脉桥和非体外循环CABG等因素与CABG术后移植血管狭窄有关。logistic回归分析结果发现:糖尿病(OR=3.654)、血脂异常(OR=2.625)、靶血管狭窄<70%(OR=1.763)、靶血管管径<1.5mm(OR=1.337)、远端吻合口位于右冠状动脉系统(OR=1.694)和大隐静脉桥(OR=1.652)是CABG术后移植血管狭窄的独立危险因素。结论糖尿病、血脂异常、靶血管狭窄<70%、靶血管管径<1.5mm、远端吻合口位于右冠状动脉系统和大隐静脉桥是CABG术后移植血管狭窄的危险因素。Objective To investigate the risk factors of grafts stenosis following coronary artery bypass grafting （CABG）, in an effort to benefit the prevention and treatment of graft stenosis after CABG. Methods The clinic data of 197 patients who underwent CABG and received selective angiography between January 1999 and December 2007 were retrospectively analyzed and all patients were subdivided into stenosis group （n = 87） and normal group （n= 110）. Statistic analysis of Χ^2 test, t-test and multiple logistic regressions were used to find out the risk factor. Results It was demonstrated by angiography that there was graft stenosis after CABG in 87 patients involved 321 stomas （305 in the distal and 16 in the proximal）. Univariate analysis revealed that diabetes mellitus,dyslipidemia, distal anastomoses in right coronary artery （RCA） territory, 〈70% stenosis in target coronary artery, 〈1.5 mm in diameter in target artery, saphenous vein grafts （SVG） and off-pump CABG were significantly related to stenosis of grafts following CABG, and logistic multivariate regression analysis showed that diabetes mellitus （OR = 3. 654）, dyslipidemia （OR= 2. 625）, distal anastomoses in RCA （OR= 1. 694）, 〈 70% s tenosis in target coronary artery（OR= 1. 763）, 〈1.5 mm in diameter in target artery （OR=1. 337）and utilization of SVG （OR= 1. 652） were independent risk factors of graft stenosis. Conclusion Diabetes mellitus,dyslipidemia, distal anastomoses in RCA, 〈 70% stenosis in target coronary artery, 〈1.5 mm in diameter in target artery and utilization of SVG are the risk factors of graft stenosis following CABG.

关 键 词：冠状动脉旁路移植术 移植血管 狭窄 危险因素 

分 类 号：R654.2[医药卫生—外科学]