大隐静脉Y型冠状动脉搭桥与序贯搭桥术后近中期临床疗效比较  

Comparison of short-term and mid-term clinical effects between Y-type coronary artery bypass grafting and sequential coronary artery bypass grafting

作　　者：鲁鼎荣 李伟[1] 董圣军[1] 刘典晓[1] 王锋[1] 吴恩刚 刘宝辉[1] 王玉玖[1] LU Dingrong;LI Wei;DONG Shengjun;LIU Dianxiao;WANG Feng;WU Engang;LIU Baohui;WANG Yujiu(Department of Cardiology and Macrovascular Surgery,Affiliated Hospital of Binzhou Medical University,Binzhou,Shandong 256600,China)

机构地区：[1]滨州医学院附属医院心脏大血管外科,山东省滨州市256600

出　　处：《中国动脉硬化杂志》2021年第3期259-263,共5页Chinese Journal of Arteriosclerosis

基　　金：山东省医药卫生科技发展计划项目(2019WS327)。

摘　　要：目的比较并评价大隐静脉Y型冠状动脉搭桥与序贯搭桥术后近中期临床疗效。方法随机选取2014年1月—2015年12月接受大隐静脉Y型冠状动脉搭桥与序贯搭桥患者各50例为研究对象。将行大隐静脉Y型吻合的患者记为观察组,行序贯吻合的患者记为对照组。对比两组患者术中静脉桥各吻合口血流量及术后3个月、6个月、1年、2年、3年的左心室射血分数(LVEF)、左心室舒张期末内径(LVEDD)、主要不良心血管事件的发生率、各自因相似症状再次入院后复查的冠状动脉造影(CAG)显示桥血管堵塞率。结果两组患者在近期(术后3个月、6个月)时刻,心功能并无明显差异,且两组患者主要不良心血管事件发生率均主要在术后中期(术后2年、3年)及以后出现。两组患者术中静脉桥各吻合口即时血流量测定方面均无统计学差异;与对照组相比,观察组于术后1年、2年、3年随访左心室射血分数(LVEF)均明显升高(P<0.05);而主要不良心血管事件发生率、血管桥及吻合口堵塞率均明显降低(P<0.05)。结论大隐静脉Y型冠状动脉搭桥较序贯搭桥更能提高患者术后左心功能,减少术后相关不良事件发生率,对提高患者术后中期生存率具有重要意义,值得临床推广。Aim To compare and evaluate the clinical effect of Y-type coronary artery bypass and sequential bypass in the near and medium term.Methods From January 2014 to December 2015,50 patients were randomly selected as the study subjects.The patients with Y-pattern anastomosis of great saphenous vein were recorded as the experimental group and the patients with sequential anastomosis as the control group.The preoperative general condition,intraoperative blood flow at each anastomotic port of vein bridge,left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),incidence of adverse cardiovascular events,CAG reexamination after admission due to similar symptoms were compared between the two groups.Results There was no significant difference in cardiac function between the two groups in the near future(3 months and 6 months after operation),and the incidence of adverse cardiovascular events was mainly in the middle postoperative period(2 and 3 years after operation)and later.There was no significant difference in body weight,age,cardiac function and instant blood flow measurement at each anastomotic site of venous bridge between the two groups before operation.Compared with the control group,the left ventricular ejection fraction(LVEF)of the observation group was significantly increased after 1,2 and 3 years of follow-up after operation(P<0.05),while the incidence of adverse cardiovascular events,vascular bridge and anastomotic occlusion rate were significantly decreased(P<0.05).Conclusion Compared with sequential coronary artery bypass grafting,Y-type saphenous vein bypass grafting can improve the postoperative cardiac function,reduce the incidence of postoperative complications and graft occlusion rate,which is of great significance to improve the mid-term survival rate of patients and worthy of clinical promotion.

关 键 词：冠心病 大隐静脉Y型冠状动脉搭桥 大隐静脉序贯冠状动脉搭桥 近中期临床疗效 

分 类 号：R5[医药卫生—内科学]