冠状动脉移植术后患者桥血管通畅情况观察  

Observation on patency of radial artery bridge in patients after coronary artery transplantation

作　　者：高文卿[1] 李彤[1] 胡晓旻[1] 吴鹏[1] 稂与恒[1] 郑伟峰 赵越[1] 马群兴 宁萌[1] GAO Wen-qing;LI Tong;HU Xiao-min;WU Peng;LANG Yu-heng;ZHENG Wei-feng;ZHAO Yue;MA Qun-xing;NING Meng(Department of Heart Center,the Third Central Hospital of Tianjin,Tianjin Key Laboratory of Artificial Cell,Artificial Cell Engineering Technology Research Center of Public Health Ministry,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院心脏中心,天津市人工细胞重点实验室,卫生部人工细胞工程技术研究中心,300170

出　　处：《天津医药》2018年第7期696-699,共4页Tianjin Medical Journal

基　　金：天津市科委重点支撑课题(16YFZCSY01060);天津市科委青年基金(17JCQNJC10000);天津市卫计委重点基金(2014KR01);天津市卫生行业重点攻关项目(14KG112)

摘　　要：目的探讨冠状动脉移植术后患者桥血管通畅情况,为临床桥血管的选择提供参考。方法回顾性分析32例冠状动脉移植术后复查冠脉造影患者的临床资料,分析大隐静脉(SVG)、左乳内动脉(LIMA)及桡动脉(RA)作为桥血管的整体使用情况及通畅情况,比较3种桥血管的近期(<5年)、中期(5~10年)及远期(>10年)通畅情况,并对RA闭塞情况进行分析。结果 32例患者桥血管使用总支数为85支,仅有1例用的右乳内动脉(RIMA),其他为SVG、LIMA、RA,使用支数分别为48、23、13支,4种桥血管整体通畅率为45.88%(39/85),SVG、LIMA、RA桥血管通畅率分别为25%(12/48)、73.91%(17/23)、69.23(9/13)。所有桥血管的近期、中期及远期的通畅率呈降低趋势,其中LIMA、RA及SVG近期通畅率差异无统计学意义,LIMA和SVG中期通畅率高于RA,而RA的远期通畅率高于LIMA及SVG,但差异亦无统计学意义。9例RA通畅病例靶血管吻合口近段有严重狭窄(>90%)或闭塞,远端血流通畅。结论桡动脉整体使用率仍偏低,整体通畅率优于大隐静脉,可作为第二优选桥血管。桡动脉应用前需做好病人选择及桡动脉评估,靶血管吻合口近端狭窄程度显著影响桡动脉桥血管远期通畅率。Objective To explore the patency of bridge vessels in patients after coronary artery transplantation,and to provide reference for the selection of clinical bridge vessels.Methods Data of 32 patients underwent coronary angiography after coronary artery bypass grafting were selected and analyzed retrospectively.The overall usage and patency of the great saphenous vein graft(SVG),the left internal mammary artery(LIMA)and the radial artery(RA)were analyzed.The patency of the near future(5 years),the medium term(5-10 years)and long term(>10 years)were compared between the three kinds of bridging vascular vessels.The RA occlusion was analyzed.Results The total number of bridge vessels used in 32 patients was 85,only 1 case used right internal mammary artery(RIMA),the others used SVG,LIMA and RA,in which 48,23 and 13 branches were used respectively.The patency rates of SVG,LIMA and RA were 25%(12/48),73.91%(17/23)and 69.23(9/13)respectively.The recent and medium-term patency rates of all bridge vessels showed a decreasing trend,in which the recent patency rate of SVG was significantly higher than that in LIMA,the intermediate patency rates of LIMA and SVG were higher than that of RA,and the long-term patency rate of RA was significantly higher than that of LIMA and SVG.There was severe stenosis(>90%)or occlusion in the proximal segment of anastomosis in the 9 radial arteries unobstructed.Conclusion The utilization rate of RA is still low,and the overall patency rate of RA is superior to the SVG.RA can be used as the second optimal bridge vessel.The patient selection and RA evaluation should be done before applying RA.The proximal stenosis degree of target vessel significantly affects the long-term patency of RA.

关 键 词：冠状动脉疾病 冠状动脉闭塞 冠状动脉移植术 桡动脉 大隐静脉 乳内动脉 通畅率 

分 类 号：R654.2[医药卫生—外科学]