冠脉旁路移植术中两种乳内动脉游离方法的临床效果对比  

Two internal mammary artery free method by coronary artery bypass grafting in clinical research

作　　者：李晓峰[1] 张伟华[1] 罗鸿[1] 马宁 臧素华[1] 李豪威 张新[1] 

机构地区：[1]郑州大学第一附属医院心外科,郑州450052

出　　处：《郑州大学学报（医学版）》2017年第3期349-352,共4页Journal of Zhengzhou University(Medical Sciences)

摘　　要：目的:对比分析冠状动脉旁路移植术(CABG)中带蒂法和骨骼化法游离乳内动脉对术后近期结果的影响。方法:选取单纯行CABG的冠心病患者526例为研究对象,分为带蒂法游离乳内动脉组(262例)和骨骼化法游离乳内动脉组(264例),分析两组围术期相关指标、主要术后并发症及随访术后桥血管通畅率等。结果:526例患者全部顺利完成手术。带蒂法游离乳内动脉组动脉桥血流量为(22.8±7.8)m L/min,游离时间为(18.1±5.5)min,获得乳内动脉长度(13.5±0.8)cm;骨骼化法游离乳内动脉组分别为(41.6±8.3)m L/min、(32.5±6.8)min和(15.8±0.9)cm,差异均有统计学意义(P<0.05)。带蒂法游离乳内动脉组手术总时间(245±21)min,围术期死亡4例,围手术期心梗12例;骨骼化法游离乳内动脉组分别为(252±18)min、5例和10例,两组各有1例胸骨不愈合,差异均无统计学意义(P>0.05)。术后随访3~12个月,两组1 a内动脉桥通畅率均为99.6%。结论:冠脉旁路移植术中,采取骨骼化与带蒂法游离乳内动脉对术后近期效果无明显差异。Aim： To compare the postoperative effect of pedicled and skeletonized free internal mammary artery after coronary artery bypass grafting（ CABG）. Methods： A total of 526 patients with coronary heart disease who underwent CABG were selected and randomly allocated into two groups,among them,262 cases in group P underwent surgery with the use of pedicle internal mammary artery,and 264 cases in group S underwent surgery with the use of skeletonized internal mammary artery. The main complications,perioperative related indicators and postoperative follow-up records of graft patency rate of the 2 groups were compared. Results： The surgery of 526 cases were successfully completed. The artery blood flow during operation in group P was（ 22. 8 ± 7. 8） mL/min and that in group S was（ 41. 6 ± 8. 3） mL/min; the time for freeing internal mammary artery was（ 18. 1 ± 5. 5） min in group P and（ 32. 5 ± 6. 8） min in group S; the length of free internal mammary artery was（ 13. 5 ± 0. 8） cm in group P and（ 15. 8 ± 0. 9） cm in groups; and there were significant differences in the above parameters between the 2 groups（ P 〈 0. 05）. The total time of surgery for group P was（ 245 ± 21）min and that for group S was（ 252 ± 18） min; perioperative death in group P and group S was 4 cases and 5 cases; there were 12 cases and 10 cases in group P and group S during perioperative period occured myocardial infarction; there was 1case in both groups developed sternal nonunion; the difference between the 2 groups had no statistical significance（ P 〉0. 05）. The patients were followed up for 3 to 12 months,and the patency rate of artery graft for the 2 groups within 1 years was both 99. 6%. Conclusion： In CABG,the skeletonized and pedicled method of obtaining free internal mammary artery have no significant effects on recent postoperative results.

关 键 词：冠脉旁路移植术 乳内动脉 骨骼化法 带蒂法 冠心病 

分 类 号：R654.2[医药卫生—外科学]