冠状动脉旁路移植术后远期左乳内动脉桥血管血流储备影响因素分析  

Analysis of long-term influencing factors of coronary flow reserve of left internal mammary artery grafts after coronary artery bypass grafting

作　　者：冯杰莉[1] 李昭屏[1] 张喆[2] 李丹[1] 刘丽娜[1] FENG Jieli;LI Zhaoping;ZHANG Zhe;LI Dan;LIU Lina(Department of Cardiology and Institute of Vascular Medicine,Peking University Third Hospital,NHK Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides,Ministry of Health,Key Laboratory of Molecular Cardiovascular Science,Ministry of Education,Beijing Key Laboratory of Cardiovascular Receptors Research,Beijing,100191,China;Department of Surgical Cardiology,Peking University Third Hospital)

机构地区：[1]北京大学第三医院心内科,血管医学研究所,国家卫健委心血管分子生物学与调节肽重点实验室,分子心血管学教育部重点实验室,心血管受体研究北京市重点实验室,北京100191 [2]北京大学第三医院心外科

出　　处：《临床心血管病杂志》2020年第6期565-569,共5页Journal of Clinical Cardiology

基　　金：北京大学第三医院院临床重点项目青年项目(No:BYSY2015015)。

摘　　要：目的:测定冠状动脉旁路移植(CABG)术后左侧乳内动脉(LIMA)桥血管血流储备(CFR),分析CABG术后远期LIMA桥血管CFR的影响因素。方法:纳入以LIMA为左前降支(LAD)桥血管的CABG术后患者107例,CABG术后时间(17.58±14.45)个月,采用经胸多普勒超声心动图测定LIMA桥血管CFR及吻合口近端LAD的CFR。结果:所有患者测得桥血管CFR,CFR桥血管为2.70±0.82,28例患者可见吻合口近端LAD逆向血流,CFRLAD为2.10±0.97。CFR桥血管<2.5患者44例(41.12%)。CFR桥血管<2.5组患者劳力性胸痛发生率明显高于CFR桥血管≥2.5组患者(29.55%∶7.94%,P=0.005)。合并高血压患者桥血管CFR明显低于无高血压患者[(2.52±0.74):(3.02±0.86),P=0.002],合并糖尿病患者桥血管CFR明显低于无糖尿病患者[(2.39±0.65):(2.85±0.86),P=0.003]。多因素分析显示高血压、糖尿病为桥血管CFR独立预测因素(P<0.05)。结论:高血压、糖尿病是CABG术后远期LIMA桥血管CFR独立预测因素,CFR桥血管<2.5患者劳力性胸痛发生率高。Objective:To measure coronary flow reserve(CFR)of the left internal mammary artery(LIMA)bypass in patients after coronary artery bypass grafting(CABG).Analyses the factors influencing LIMA bypass CFR in the long term after CABG.Method:One hundred and seven patients after CABG using LIMA as the bypass of left anterior descending(LAD)were included,and the follow-up time after CABG was(17.58±14.45)months.CFR of LIMA bypass was measured by transthoracic doppler echocardiography.Result:The CFRbypassin all patients was 2.70±0.82.The reverse flow of LAD in the proximal anastomotic site was found in 28 patients,and the CFRLADwas 2.10±0.97.44(41.12%)patients had CFRbypass<2.5.The incidence of exertive chest pain in patients with CFRbypass<2.5 was significantly higher than that in patients with CFRbypass≥2.5(29.55%∶7.94%,P=0.005).CFRbypassin patients with hypertension was significantly lower than that in patients without hypertension[(2.52±0.74):(3.02±0.86),P=0.002],and CFRbypassin patients with diabetes mellitus were significantly lower than that in patients without diabetes mellitus[(2.39±0.65):(2.85±0.86),P=0.003].Multiple analysis showed that hypertension and diabetes mellitus were the independent predictors for CFRbypass(P<0.05).Conclusion:Hypertension and diabetes mellitus were independent predictors for CFR of LIMAbypass in the long term after CABG,and the incidence of exertive chest pain was high in patients with CFRbypass<2.5.

关 键 词：冠状动脉旁路移植术 左侧乳内动脉 冠状动脉血流储备 经胸多普勒超声心动图 

分 类 号：R541.4[医药卫生—心血管疾病] R540.45[医药卫生—内科学]