冠状动脉旁路移植术双桡动脉桥多中心应用的中期结果  

Mid-term multi-center outcomes of bilateral radial artery as conduits in coronary artery bypass grafting

作　　者：陈绪军 郑宝石[2] 张永[3] 乔晨晖[4] 曹勇[5] 柳德斌[6] 魏翔[7] 凌云鹏[8] 李伟栋[9] 黄克力[10] 武忠[11] 余成[12] 周继梧 郭海平[14] 胡明松 郭能瑞 杨文凯 陆辉辉 孟自力[19] Chen Xujun;Zheng Baoshi;Zhang Yong;Qiao Chenhui;Cao Yong;Liu Debin;Wei Xiang;Ling Yunpeng;Li Weidong;Huang Keli;Wu Zhong;Yu Cheng;Zhou Jiwu;Guo Haiping;Hu Mingsong;Guo Nengrui;Yang Wenkai;Lu Huihui;Meng Zili(Department of Cardiac Surgery, Wuhan First Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022,China;Department of Cardiac Surgery, Sichuan Provincial People's Hospital, Chengdu 610072,China;Department of Cardiovascular Surgery, West China Hospital, Sichuan University,Chengdu 610041,China;Department of Cardiovascular Surgery, Hainan General Hospital, Haikou 570311,China;Department of Cardiothoracic Surgery,Cangzhou Central Hospital, Cangzhou 061001,China;Department of Cardiac Surgery, Handan First Hospital, Handan 056002,China;Department of Cardiothoracic Surgery, Second. Hospital, University of South China, Hengyang 421001,China;Department of Cardiac Surgery, Yuncheng First Hospital, Yuncheng 044000,China;Department of Cardiothoracic Surgery, Ganzhou Hospital of Jiangxi Province,Ganzhou 341000,China;Department of Cardiothoracic Surgery, Hunan Provincial Hospital of Traditional Medicine,Zhuzhou 412000,China;Department of Cardiac Surgery, Hebei Chest Hospital,Shijiazhuang 050041,China;Department of Cardiac Surgery,the First Affiliated Hospital of Guangxi Medical University, Nanning 530021,China;Department of Cardiac Surgery, Beijing Friendship Hospital, Capital Medical University,Beijing 100059,China;Department of Cardiac Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052,China;Department of Cardiovascular Surgery, Gaozhou People's Hospital, Gaozhou 525200,China;Department of Cardiac Surgery, Second Hospital of Lanzhou University, Lanzhou 730030,China;Department of Cardiovascular Surgery, Tongji Medical School of Huazhong University of Science and Technology,Wuhan 430022,China;Department of Cardiac Surgery, Peking University Third Hospital, Beijing 100191,China;Department of Cardiothoracic Surgery, First Affiliated Hospital, Zhejiang Universit

机构地区：[1]华中科技大学同济医学院武汉第一医院心外科,武汉430022 [10]四川省人民医院心外科,成都610072 [11]四川大学华西医院心脏大血管外科,成都610041 [12]海南省人民医院心血管外科,海口570311 [13]河北省沧州中心医院心胸外科,沧州061001 [14]河北省邯郸市第一医院心外科,邯郸056002 [15]南华大学附属第二医院心胸外科,衡阳421001 [16]山西省运城市第-医院心外科,运城044000 [17]江西省赣州市人民医院心胸外科,赣州341000 [18]湖南省直中医院心胸外科,株洲412000 [19]河北省胸科医院心外科,石家庄050041 [2]广西医科大学第一附属医院心脏外科,南宁530021 [3]首都医科大学附属北京友谊医院心外科,北京100059 [4]郑州大学第一附属医院心外科,郑州450052 [5]广东省高州市人民医院心血管外科,高州525200 [6]兰州大学第二附属医院心外科,兰州730030 [7]华中科技大学同济医学院附属同济医院心脏大血管外科,武汉430022 [8]北京大学第三医院心外科,北京100191 [9]浙江大学医学院附属第一医院心胸外科,杭州310006

出　　处：《中华医学杂志》2019年第14期1069-1074,共6页National Medical Journal of China

摘　　要：目的探讨双桡动脉桥(BRA)在冠状动脉旁路移植术(CABG)的中期治疗效果。方法回顾性分析2013年8月至2018年9月我国19家医院运用BRA进行CABG的临床资料,包括围手术期并发症及随访结果。结果共有211例患者(男170例,女41例)运用BRA,年龄41~73(56.5±9.7)岁,冠状动脉三支病变161例,双支病变50例。术前合并糖尿病90例,周围血管病35例,慢性阻塞性肺疾病4例,瓣膜病11例。非体外循环CABG 2例,体外循环CABG 209例,同期瓣膜手术11例。161例运用左胸廓内动脉,全动脉化210例,远端吻合口2~4(2.7±0.9)个。无手术死亡,术后心房颤动12例,前臂血肿1例,胸腔出血7例,低氧血症13例,肺部感染1例。气管插管时间3.5~20.3(8.3±4.7)h,术后住院6~13(7.1±2.9)d。共有191例(90.52%)得到随访,随访时间3~59(35.5±9.3)个月。术后3个月左室射血分数明显增加(61.0%±7.2%比47.1%±5.3%,P=0.017)。1例患者术后14个月死于脑外伤,其余均存活,无重要心血管事件发生。62.6%(132例)的患者在术后(21.5±6.4)个月经冠状动脉CT血管造影(CTA)证实BRA通畅。术后1年与3年累积生存率分别为100%与99.53%。结论BRA在CABG术围手术期安全、并发症少,易于全动脉化而且中期效果优越。Objective To evaluate the mid-term outcomes of bilateral radial artery (BRA) grafts in coronary artery bypass grafting (CABG). Methods All perioperative medical records and follow-up results of CABG with BRA grafts in multi-centers of China were analyzed retrospectively. ResultsA total of 211 patients (170 males and 41 females) underwent CABG grafting with BRA conduits between August 2013 and September 2018, with a mean age of (56.5±9.7) years old (rang 41 to 73 years). There were 161 cases of triple-vessel disease and 50 cases of two-vessel disease. Ninety patients had diabetes mellitus (DM), 35 patients with peripheral vascular disease, 4 patients with chronic obstructive pulmonary disease and 11 with heart valve disease. Two patients underwent off-pump CABG and 209 patients accepted on-pump CABG with commitment valve surgery. There were 210 cases of total arterial revascularization and 161 cases using left thoracic artery conduits, with a graft number of 2-4 (2.7±0.9). No operation-related death occurred, atrial fibrillation happened in 12 patients, hemothorax in 7 cases, and forearm hematoma in one case, hypoxemia in 13 cases and pneumonia in one case. The duration of mechanical ventilation was (8.3±4.7) hours and the mean hospital length of stay was (7.1±2.9) days. Follow-up was completed in 191 patients (90.52%) with a duration of 3-59 (35.5±9.3) months. The mean left ventricular ejection fraction at 3 months after operation was significantly improved, compared to that of the pre-operation (61.0%±7.2% vs 47.1%±5.3%, P=0.017). All patients survived, except that one died from brain injury. No major cardiac events occurred, with a cumulative survival rate of 100% at 1 year and 99.53% at 3 year after operation, respectively. It was showed in coronary CT angiography (CTA) examination that all grafts in 132 patients were patent at the mean follow-up duration of (21.5±6.4) months. Conclusions BRA grafts as arterial conduit in CABG are proved to be safe, easy for total arterial revascularization and have go

关 键 词：冠状动脉旁路移植术 桡动脉 治疗结果 多中心 

分 类 号：R654.2[医药卫生—外科学]