冠状动脉旁路移植术治疗年龄≤40岁冠心病患者术后中期疗效分析  

Mid-term outcome of coronary artery bypass graft surgery in patients aged≤40 years with coronary heart disease

作　　者：宋凯[1] 陆树洋[1] 孙晓宁[1] 张红强[1] 陈金淼[1] 胡馗[1] 洪涛[1] 丁文军[1] 夏利民[1] 王春生[1] SONG Kai LU Shu-yang SUN Xiao-ning ZHANG Hong-qiang CHEN Jin-miao HU Kui HONG Tao DING Wen-jun XIA Li-min WANG Chun-sheng(Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, Chin)

机构地区：[1]复旦大学附属中山医院心外科,上海200032

出　　处：《复旦学报（医学版）》2017年第4期472-475,共4页Fudan University Journal of Medical Sciences

基　　金：国家自然科学基金青年项目(81501595)~~

摘　　要：目的探讨年龄≤40岁冠心病患者的临床特点、外科治疗经验及冠状动脉旁路移植术后的中期疗效。方法 2009年1月至2015年12月复旦大学附属中山医院单中心诊断为冠心病且年龄≤40岁于心脏外科行手术治疗的患者共12例,其中男性10例,女性2例,平均年龄(37.9±2.5)岁(32~40)岁。该组病例临床特点包括,有高血压病史5例,糖尿病史3例,高脂血症病史4例,有吸烟史8例,术前心梗病史7例,3支主干中不少于1支全闭6例,2例反复行PCI术,分别植入支架5枚和3枚。回顾性分析患者的临床资料、外科手术治疗情况及随访结果。结果围手术期及随访期间均无死亡。采用双侧乳内动脉联合桡动脉全动脉化冠状动脉旁路术6例,双侧乳内动脉联合大隐静脉冠状动脉旁路术2例,左侧乳内动脉联合大隐静脉冠状动脉旁路术4例。非体外下冠状动脉旁路术9例,体外循环辅助下冠状动脉旁路术3例。平均随访时间(47.8±24.3)个月,随访过程中1例术后5年静脉桥出现再狭窄,于心内科行经皮冠状动脉介入术,其余11例随访心功能恢复至Ⅰ~Ⅱ级。结论年轻冠心病患者(年龄≤40岁)因心功能代偿良好一般发病较隐匿,临床诊断时冠脉病变较严重。冠状动脉旁路术预后良好,手术中远期疗效满意。Objective To investigate the clinical characteristics, surgical experience and mid-term outcome of coronary artery bypass graft surgery in patients aged≤40 years. Methods From Jan., 2009 to Dec., 2015, 12 patients with median age of （37.9±2.5） years （range 32-40 years, 10 males） were diagnosed with coronary artery disease and underwent coronary artery bypass graft surgery at Zhongshan Hospital, Fudan University. The clinical characteristics included five cases with hypertension, three cases with diabetes mellitus, four cases with hyperlipemia, eight cases with smoking history, seven cases with myocardial infarction. Six cases had at least one branch totally occluded. Two cases once underwent percutaneous coronary intervention surgery and implanted with five and three stents respectively. The perioperative data and follow-up results were retrospectively analysed. Results There was no in-hospital death and no death during follow-up period. Surgical techniques included bilateral internal mammary arteries combined with radial artery were operated in six cases, bilateral internal mammary arteries combined with great saphenous vein in two cases, left internal mammary arteries combined with great saphenous vein in four cases, off-pump in nine cases and on-pump in three cases. The mean follow-up time was （47.8±24.3） months. During the follow-up one case suffered with saphenous vein graft restenosis 5 years after the surgery and underwent percutaneous coronary intervention. Other cases were all alive and assessed New York Heart Association’s function class Ⅰ-Ⅱ. Conclusions Younger patients usually suffer with severe coronary artery disease when diagnosed because they often have excellent compensative capacity and the pathogenesis is concealed. The mid-term results of coronary artery bypass graft surgery in patients aged≤40 years are satisfactory.

关 键 词：冠状动脉旁路移植术 冠心病 手术策略 

分 类 号：R654.2[医药卫生—外科学]