中国常用动脉化冠状动脉旁路移植术的通畅率及疗效  

Effects and Patency of Coronary Artery Bypass Grafting Used in China

作　　者：齐弘炜[1] 袁彪[1] 

机构地区：[1]首都医科大学附属北京同仁医院心血管疾病诊疗中心,北京100730

出　　处：《心血管病学进展》2015年第5期559-563,共5页Advances in Cardiovascular Diseases

基　　金：国家自然科学基金(81370237)

摘　　要：目前冠状动脉旁路移植术通常采用一支乳内动脉加一支或多支大隐静脉作为桥血管,大隐静脉会逐渐粥样硬化而闭塞,动脉的通畅率远高于大隐静脉。左乳内动脉已常规应用于冠状动脉旁路移植术,同应用双侧乳内动脉相比,左乳内动脉加大隐静脉被认为是远期死亡、心脏事件的独立危险因素。乳内动脉用于左侧冠状动脉时通畅率一样;原位或复合桥移植时所有的乳内动脉通畅率相同,但吻合于主动脉时通畅率降低,所以原位乳内动脉通畅率高于游离乳内动脉。胃网膜右动脉和桡动脉宜吻合于近端狭窄严重者。双侧乳内动脉+胃网膜右动脉可避免触及主动脉,最大程度地减少脑部并发症的发生。70岁以下冠状动脉旁路移植术、预期寿命5年以上者,应选择双侧乳内动脉;60岁以下没有或很少合并症的冠状动脉旁路移植术患者可考虑全动脉化搭桥手术。One internal-mammary-artery（IMA） and one or more saphenous vein（SV） were commonly used in coronary artery bypass grafting. However, SV will occlude with progressive atheroselerosis. The expansion of obstructions （patency） of arterial grafts was much bet- ter than saphenous vein grafts（SVG）. Left IMA（LIMA） was routinely used in coronary artery bypass grafting. However in comparison with group bilateral IMA（ BIMA）, LIMA ＋ SV（s） was an independent risk factor from lower chances of cardiac death, acute myocardial infarc- tion, acute myocardial infarction in a grafted area and cardiac events. Both IMA have similar patency when used on left-sided coronaries and as in-situ or composite grafts, but have inferior pateney if anastomosed to aorta. Therefore the patency of IMA in-situ was superior than the free IMA. Right gastroepiploie artery and radial artery was suitable anastomose to the coronary artery with severe proximal stenosis. BIMA with right gastroepiploic artery could decrease the central nervous system complications as far as possible because of it does not touch the aor- ta. When a patient undergoes their first coronary surgery and is younger than 70 years, BIMA grafting should not be denied, especially if their life expectancy is higher than 5 years. Complete arterial revaseularization may be reasonable for patients less than or equal to 60 years of age with few or no co-rnorbidities.

关 键 词：冠状动脉旁路移植术 全动脉化 通畅率 疗效 

分 类 号：R654.2[医药卫生—外科学]