冠状动脉旁路移植术后移植血管通畅率的影响因素分析  

Influential Factors for Graft Patency after Coronary Artery Bypass Grafting

作　　者：刘畅[1] 肖喜刚[2] 王柏春[1] 吴丹[1] 徐磊[1] 刘宏宇[1] 

机构地区：[1]哈尔滨医科大学附属第一医院心血管外科,哈尔滨150001 [2]哈尔滨医科大学附属第一医院CT影像科,哈尔滨150001

出　　处：《中国胸心血管外科临床杂志》2012年第6期606-609,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：黑龙江省卫生厅资助项目(2010-034)~~

摘　　要：目的分析冠状动脉旁路移植术(CABG)后1年移植血管通畅率及危险因素。方法前瞻性连续纳入哈尔滨医科大学附属第一医院2010年6～12月行CABG患者71例,其中男37例,女34例;年龄(59.8±7.7)岁,由同一术者主刀完成手术,术后用标准药物治疗。术后1年行冠状动脉256排多层螺旋CT检查,根据移植血管通畅与否,将患者分为闭塞组(n=16)和通畅组(n=55)。收集术前、术中和术后随访资料,通过单因素分析和logistic多因素回归分析筛选导致移植血管病变的危险因素。结果术后1年移植血管通畅率为91.0%(172/189)。单因素分析结果显示,术前胆固醇水平(t=-2.389,P=0.017)、血管弥漫性病变(χ2=4.449,P=0.042)、靶血管直径(t=5.064,P=0.000)、术后未规范服用抗血小板药物(χ2=10.175,P=0.008)是移植血管病变的潜在危险因素。logistic多因素回归分析结果显示,靶血管狭窄[RR=0.014,95%CI(0.001,0.228),P=0.003]和术后未规范服用抗血小板药物[RR=13.375,95%CI(1.075,175.536),P=0.044]是移植血管病变危险因素。结论 CABG患者术后1年移植血管通畅率较高,移植血管通畅率与靶血管狭窄及术后抗血小板药物的规范服用相关。Objective To evaluate graft patency at one year after coronary artery bypass grafting（CABG） and analyze the risk factors of graft occlusion.Methods We prospectively included 71 consecutive patients with coronary heart disease who underwent CABG in First Affiliated Hospital of Harbin Medical University from June to December 2010.There were 37 males and 34 females with their average age of 59.8±7.7 years.All the patients underwent CABG performed by the same surgeon,and received standard drug therapy after surgery.At 1 year after CABG,256-slice multislice computed tomography（MSCT） angiography was performed to evaluate graft patency.All the patients were divided into two groups according to their graft patency during follow-up,including 16 patients in the occluded graft group and 55 patients in patent graft group.Preoperative,intra-operative and postoperative variables were collected.Univiariate analysis and logistic regress analysis were performed to analyze risk factors of graft occlusion.Results The graft patency was 91.0%（172/189） at 1 year after CABG.Univiariate analysis showed that pre-operative cholesterol（t=-2.389,P=0.017）,diffused coronary artery disease（χ2=4.449,P=0.042）,diameter of target vessels（t=5.064,P=0.000）,non-adherence to prescribed antiplatelet medications（χ2=10.175,P=0.008） were potential risk factors of graft occlusion after CABG.Logistic regress analysis showed that diameter of target vessels [RR=0.014,95% CI（0.001,0.229）,P=0.003] and non-adherence to prescribed antiplatelet medications [RR=13.375,95% CI（1.075,175.536）,P=0.044] were significant risk factors for graft occlusion.Conclusion The graft patency is satisfactory at 1 year after CABG.Graft patency after CABG is closely related to the stenosis degree of target vessels and adherence to prescribed antiplatelet medications after surgery.

关 键 词：冠状动脉旁路移植术 移植血管 通畅率 影响因素 

分 类 号：R654.2[医药卫生—外科学]