桡动脉在中国人动脉化冠状动脉旁路移植术中的应用  

Application of radial artery in arterialized coronary artery bypass grafting in Chinese patients

作　　者：何国伟[1] 刘晓程[1] 刘志刚[1] 王正清[1] 陈铁男 李欣[1] He Guowei;Liu Xiaocheng;Liu Zhigang;Wang Zhengqing;Chen Tienan;Li Xin(Department of Cardiovascular Surgery,TEDA International Cardiovascular Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Tianjin 300457,China)

机构地区：[1]中国医学科学院北京协和医学院泰达国际心血管病医院心血管外科,天津300457

出　　处：《中华医学杂志》2019年第42期3318-3322,共5页National Medical Journal of China

摘　　要：目的总结采用桡动脉作为除乳内动脉外的第二个动脉桥进行冠状动脉旁路移植术的应用情况.方法回顾性分析2015年1月1日至2019年6月11日期间在泰达国际心血管病医院心血管外科行冠状动脉旁路移植术的患者临床资料,选取其中采用桡动脉行旁路移植术的病例,分析桡动脉、乳内动脉和大隐静脉的应用方式、靶血管及手术结果.结果在上述期间共完成2901例冠状动脉旁路移植术,其中208例(7.2%)采用了桡动脉.男197例,女11例,年龄(53±8)岁,每例平均搭桥数3.79根.桡动脉的靶血管依次为第一钝缘支(102例),第一对角支(50例),右冠主干或后降支(40例),中间支(22例)等.其中172例为单根远端吻合口,其近端吻合到升主动脉(168例),大隐静脉桥(3例),原位乳内动脉(1例);72例为桡动脉序贯桥,其近端吻合到升主动脉(58例),大隐静脉桥(13例),原位乳内动脉(1例).左乳内动脉的目标血管主要为左前降支(188例)及对角支(10例).大隐静脉的目标血管为采用乳内动脉及桡动脉时的其他靶血管.手术时间(5.0±1.5)h,住院天数(17.4±6.4)d.术后6例再次开胸,其中5例因引流液多,1例因室性心律失常致血流动力学不稳定.手术死亡率为0,患者均顺利出院.结论在中国患者中使用乳内动脉、桡动脉,配合大隐静脉行冠状动脉旁路移植术可以获得良好的手术结果.Objective To summarize the application of radial artery(RA)as the second arterial graft in coronary artery bypass grafting(CABG).Methods From January 1,2015 to June 11,2019,the clinical data of all patients undergoing CABG in TEDA International Cardiovascular Hospital was retrospectively reviewed.The patients who underwent RA grafting were included.The application of RA,internal mammary artery(IMA)and the saphenous vein,their target vessels,and the operative results were analyzed.Results A total of 2901 patients underwent CABG.Of those,208 patients(7.2%)had RA grafting,with 197 males and 11 females.The average age was(53±8)years old and the average grafts per patient was 3.79.The target vessel for RA was first obtuse marginal(OM,102 cases),first diagonal(50 cases),right coronary artery(RCA)or posterior descending artery(PDA)(40 cases),intermediate(22 cases),respectively.Among those,172 were single distal anastomosis with the proximal end anastomosed to the ascending aorta(168 cases),saphenous vein(SV)graft(3 cases)and IMA(1 case).Seventy-two patients accept sequential grafting with the proximal to the ascending aorta(58 cases),SV graft(13 cases)and IMA(1 case).The left IMA was mainly anastomosed to left descending artery(LAD)(188 cases)and diagonal(10 cases).The target vessels for SV were remaining coronary arteries when the IMA and RA were used.The operative time was(5.0±1.5)h.The hospital stay was(17.4±6.4)d.There were 6 cases undergoing exploratory thoracotomy for bleeding(5 cases)or hemodynamic instability due to ventricular arrhythmia(1 case).There was no death.All patients were successfully discharged.Conclusions Use of the RA and IMA with additional SV for CABG exhibits good results in the Chinese patients.Currently available clinical protocols are effective and safe.

关 键 词：冠状动脉疾病 冠状动脉分流术 桡动脉 乳内动脉 大隐静脉 

分 类 号：R54[医药卫生—心血管疾病]