70岁以上冠心病患者应用左乳内动脉行左前降支搭桥术的疗效观察  

Left internal mammary artery in left anterior descending artery bypass graft in coronary heart disease patients aged over 70 years

作　　者：轩继中 程兆云 孙俊杰 胡俊龙 XUAN Ji-zhong;CHENG Zhao-yun;SUN Jun-jie;HU Jun-long(Department of Adult Cardiac Surgery,Heart Center of Henan Provincial People’s Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou University People’s Hospital,Zhengzhou,Henan 451464,China)

机构地区：[1]河南省人民医院,阜外华中心血管病医院,郑州大学人民医院成人心脏外科,河南郑州451464

出　　处：《中华实用诊断与治疗杂志》2022年第7期702-704,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(2018020456)。

摘　　要：目的比较70岁以上冠心病患者冠状动脉旁路移植术中采用左乳内动脉(left internal mammary artery,LIMA)、大隐静脉(saphenous vein,SV)作为左前降支桥血管的近期疗效,探讨其安全性。方法70岁以上冠心病患者254例,均行非体外循环心脏不停跳冠状动脉旁路移植术,术中采用LIMA作为左前降支桥血管者198例为LIMA组,采用SV作为左前降支桥血管者56例为SV组。比较2组性别、年龄、合并症、病史、术前左室射血分数等临床资料;记录2组手术时间、搭桥支数、术后24 h胸腔引流量、ICU停留时间、术后住院时间、输血及术前行颈动脉支架、肾动脉支架手术比率;比较2组院内死亡及术后心肌梗死、脑梗死、恶性室性心律失常、二次开胸止血、胸骨愈合不良发生情况。结果2组年龄,术前左室射血分数,男性及合并高血压、糖尿病、高脂血症、慢性阻塞性肺疾病、肾功能不全比率,有心肌梗死史、经皮冠状动脉介入治疗史、脑梗死史比率比较差异均无统计学意义(P>0.05)。2组手术均顺利完成,LIMA组手术时间[(260.21±37.09)min]、搭桥支数[(3.80±0.69)支]、术后24 h胸腔引流量[(349.52±123.72)mL]、ICU停留时间[(50.26±14.38)h]、术后住院时间[(11.60±3.66)d]、输血及术前行颈动脉支架、肾动脉支架手术比率(18.69%、3.03%、1.52%)与SV组[(255.23±54.09)min、(3.63±0.78)支、(332.59±146.09)mL、(51.98±16.55)h、(11.14±4.87)d、17.86%、3.57%、1.79%]比较差异均无统计学意义(P>0.05)。LIMA组术后心肌梗死发生率(1.01%)低于SV组(7.14%)(χ^(2)=4.708,P=0.030),院内病死率及二次开胸止血、脑梗死、恶性室性心律失常、胸骨愈合不良发生率与SV组比较差异均无统计学意义(P>0.05)。结论70岁以上冠心病患者行冠状动脉动脉旁路移植术采用LIMA作为左前降支桥血管可降低术后心肌梗死发生风险,不增加围术期并发症发生率。Objective To compare the short-term clinical effect of the applications of left internal mammary artery(LIMA)and saphenous vein(SV)as left anterior descending artery bypass graft in patients aged over 70 years,and to investigate the safety.Methods Totally 254patients aged over 70 years underwent off-pump coronary artery bypass grafting,during which 198patients used LIMA as the bridge material(LIMA group)and 56 patients used SV as the bridge material(SV group)in left anterior descending artery bypass grafting.The clinical data were compared between two groups,including age,gender,complications,disease history,preoperative left ventricular ejection fraction,operation lasting time,average number of bypass branches,postoperative 24-h thoracic drainage,length of ICU stay,length of postoperative hospital stay,blood transfusion,percentages of preoperative carotid stenting and renal artery stenting,postoperative in-hospital death,and incidences of postoperative myocardial infarction,cerebral infarction,malignant ventricular arrhythmia,secondary thoracotomy for hemostasis,and dysplasia of sternum.Results There were no significant differences in the age,preoperative left ventricular ejection fraction,percentages of male patients and patients with hypertension,diabetes,hyperlipidemia,chronic obstructive pulmonary disease,renal insufficiency,history of myocardial infarction,percutaneous coronary interveution history,and history of cerebral infarction between two groups(P>0.05).All operations were performed successfully.There were no significant differences in the operation lasting time[(260.21±37.09)min vs.(255.23±54.09)min],mean number of bypass branches(3.80±0.69 vs.3.63±0.78),postoperative 24-h thoracic drainage volume[(349.52±123.72)mL vs.(332.59±146.09)mL],length of ICU stay[(50.26±14.38)h vs.(51.98±16.55)h],length of postoperative hospital stay[(11.60±3.66)d vs.(11.14±4.87)d],and percentages of patients receiving blood transfusion,preoperative carotid stenting,and preoperative renal artery stenting(18.69%vs.1

关 键 词：冠心病 冠状动脉旁路移植术 左前降支 左乳内动脉 大隐静脉 并发症 

分 类 号：R654.2[医药卫生—外科学]