医用化学胶外支架改善冠状动脉旁路移植术后静脉旁路移植血管通畅率的随访研究  

Follow-up study on improvement of vascular patency rate of vein bypass graft after coronary artery bypass grafting with medical chemical external stent

作　　者：戴龙圣 高铭鑫[1] 于文渊[1] 李波[1] 顾承雄[1] 于洋[1] Dai Longsheng;Gao Mingxin;Yu Wenyuan;Li Bo;Gu Chengxiong;Yu Yang(Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, 100029)

机构地区：[1]首都医科大学附属北京安贞医院,100029

出　　处：《中华胸心血管外科杂志》2019年第6期357-360,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 探讨医用化学胶作为血管外支架改善冠状动脉旁路移植术后静脉旁路移植血管通畅率的效果,评价其临床意义.方法 回顾性收集2010年4月至2016年12月200例在北京安贞医院行冠状动脉旁路移植术的患者临床资料.所有患者均存在不同程度的心绞痛症状,冠状动脉造影结果显示为三支病变,数字表法随机分为喷胶组和未喷胶组,各100例.喷胶组:行冠状动脉旁路移植术,同时在静脉旁路移植血管表面喷涂医用化学胶.未喷胶组:单纯行冠状动脉旁路移植术.2018年6月随访该200例患者,随访内容主要包括:患者近期心绞痛复发症状、近期超声心动图、心电图、冠状动脉CTA或冠状动脉造影结果,以及目前生存状况等.汇总比较所得数据资料.结果 喷胶组随访率96%,未喷胶组随访率92%.与未喷胶组相比较,喷胶组出现胸痛、心绞痛等症状的发生比例明显降低(23.96%对40.22%,P<0.05),静脉旁路移植血管闭塞率显著下降(29.17%对55.43%,P<0.05),心因性死亡事件发生比例明显下降(1.04%对6.52%,P<0.05),总死亡事件发生比例明显下降(4.17%对11.96%,P<0.05),主要不良心脑血管事件(MACCE)发生比例显著下降(9.38% 对21.74%,P<0.05),差异均有统计学意义.同时,喷胶组出现心衰及再发心肌梗死的患者数量相对更少,但两组差异无统计学意义(P>0.05).以MACCE为随访终点绘制生存曲线,结果显示喷胶组明显优于未喷胶组.结论 医用化学胶作为血管外支架有益于改善冠状动脉旁路移植术后静脉旁路移植血管通畅率,为有效防治冠状动脉旁路移植术后静脉旁路移植血管再狭窄提供了可靠地依据.Objective To evaluate the efficacy and clinical significance of medical chemical glue as an external stent in improving the fluency rate of venous bypass graft after coronary artery bypass grafting. Methods Randomly selected 200 patients from April 2010 to December 2016 included who were underwent coronary artery bypass grafting in Beijing Anzhen Hospital. All patients had different degrees of angina, and coronary angiography showed multi-branches artery lesion. They were randomly divided into two groups, 100 in each group. Spray gel group: coronary artery bypass grafting simultaneously spraying medical chemical glue on the surface of the bridge vessel. Unsprayed gel group: simple coronary artery bypass grafting. All 200 patients were followed up in June 2018. The follow-up content mainly included: recent recurrence of angina pectoris, recent echocardiography and electrocardiogram report, coronary CTA or coronary angiography results, and current living conditions. The data obtained were collectively summarized and compared. Results The follow-up rate was 96% in the sprayed group, and 92% in the unsprayed group. Compared with the unsprayed group , the incidence of chest pain and angina pectoris was significantly lower in the sprayed group(23.96% vs. 40. 22%, P <0. 05), the venous occlusion rate of the vein bypass graft in the sprayed group was significantly lower(29. 17% vs. 55.43%, P <0.01 ), the probability of death due to cardiac causes in the sprayed group was significant decrease( 1.04% vs. 6.52%, P <0. 05), the number of patients with the main adverse cardiac and cerebral events( MACCE) in the sprayed group was significantly lower(9. 38% vs. 21.74%, P <0. 01), all with statistically significant differences. The number of patients with heart failure and recurrent myocardial infarction was lower in the sprayed group, but there were no statistically significant differences. Conclusion Medical chemical glue as an externalstent does play a role in improving the venous patency rate after coronary artery bypass gra

关 键 词：医用化学胶 血管外支架 静脉旁路移植血管 再狭窄 冠状动脉旁路移植术 

分 类 号：R654.2[医药卫生—外科学]