冠状动脉旁路移植术中应用骨骼化与带蒂左乳内动脉的随机对照试验  

Skeletonized versus Pedicle Left Internal Mammary Artery in Coronary Artery Bypass Grafting: A Randomized Controlled Trial

作　　者：房勤[1] 谷天祥[1] 刘波[1] 师恩祎[1] 张玉海[1] 喻磊[1] 

机构地区：[1]中国医科大学附属第一医院心脏外科,沈阳110001

出　　处：《中国胸心血管外科临床杂志》2015年第4期332-336,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）中应用骨骼化左乳内动脉（LIMA）移植的临床经验。方法选取2013年1~4月于中国医科大学附属第一医院行单纯CABG的冠状动脉粥样硬化性心脏病患者122例,其中男77例、女45例,年龄41~76（62.8±10.5）岁。将患者采用随机数字表法分为两组：A组,60例,使用骨骼化LIMA;B组,62例,使用带蒂LIMA,LIMA均吻合到前降支上。结果术中获取LIMA过程中,A、B组各有1例失败而改为大隐静脉移植,被排除在外。术后A组和B组的其余病例分别发生围手术期心肌梗死2例（3.4%）和3例（4.9%）,两组差异无统计学意义（P〉0.05）;院内各死亡1例,死亡率分别为1.7%和1.6%,两组差异无统计学意义（P〉0.05）。A组无纵隔感染,B组有1例纵隔感染,两组差异无统计学意义（P〉0.05）。A组游离LIMA时间长于B组[（30.7±7.2）min vs（17.2±5.6）min,P〈0.05],差异有统计学意义。术后随访6~10个月,术后6个月冠状动脉CT显示A、B两组LIMA血管通畅率分别为96.8%和100.0%,差异无统计学意义（P〉0.05）。结论利用合适的技术获取骨骼化LIMA作为血管材料进行CABG的近期临床效果满意。Objective To explore the effect of skeletonized left internal mammary artery（LIMA） in coronary artery bypass grafting（CABG）. Methods A total of 122 patients who underwent pure CABG were recruited in the study in the First Affiliated Hospital of China Medical University between January and April 2013. There were 77 males and 45 females with age of 41-76（62.8±10.5） years. They were randomly assigned to received CABG with skeletonized LIMAs（group A, 60 patients） or pedicle LIMAs（the group B, 62 patients） by random digital table. LIMAs were all anastomosised to the left anterior descending artery. Results There was one patient failure in harvesting LIMA process in the group A and B respectively, and they were changed to saphenous vein grafts and excluded from the criteria. There were 2 and 3 patients of postoperative myocardial infarction in the group A and in the group B respectively, with incidence rate of 3.4% and 4.9% respectively（P〉0.05）. One patient died in each group during hospitalization with hospital mortality rates of 1.7% and 1.6% respectively（P〉0.05）. Complications such as mediastinal infection occurred zero and one patient in the group A and in the group B respectively（P〉0.05）. LIMA harvesting time of the group A was statistically longer than that of the group B（30.7±7.2 min vs. 17.2±5.6 min, P〈0.05）. In six months of follow-up after surgery, coronary CT showed patency rate of LIMA in the group A and in the group B was 96.8% and 100.0% respectively（P〉0.05）. Conclusion The recent effect of skeletonized LIMA as graft material in CABG is satisfactory.

关 键 词：冠状动脉旁路移植术 骨骼化左乳内动脉 冠状动脉粥样硬化性心脏病 

分 类 号：R654.2[医药卫生—外科学]