桡动脉桥使用策略对冠状动脉旁路移植术中桥血流及早期通畅性的影响  

Impact of Radial Artery Graft Anastomosis Strategies on Flow Characteristics and Early Patency in Coronary Artery Bypass Grafting

作　　者：韩增强[1] 范桄溥[1] 赵舟[1] 史艺 陈彧[1] HAN Zengqiang;FAN Guangpu;ZHAO Zhou;SHI Yi;CHEN Yu(Cardiac Surgery Department,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院心脏外科,北京100044

出　　处：《中国循环杂志》2024年第2期127-132,共6页Chinese Circulation Journal

基　　金：北京大学人民医院研究与发展基金(RDY2019-32)。

摘　　要：目的:分析桡动脉桥的不同使用策略对冠状动脉旁路移植术(CABG)中桥血流及早期通畅性的影响。方法:回顾性分析2019年1月至2021年12月我院使用桡动脉桥行CABG的99例患者临床资料,其中男性92例(92.9%),平均年龄(57.2±8.7)岁。按桡动脉桥近端吻合部位不同分为升主动脉组(n=79,吻合在升主动脉)和复合桥组(n=20,吻合在其他桥血管上)。应用瞬时流量测定技术测量桥血流各项参数,围术期及术后1年行冠状动脉CT血管造影(CTA),评价桥血管通畅情况。结果:术前两组患者的一般临床资料差异均无统计学意义(P均>0.05)。全部患者无围术期死亡。与升主动脉组比,复合桥组行微创CABG比例更高,桡动脉桥平均血流量更高(P均<0.05)。围术期冠状动脉CTA显示桡动脉桥失败24例(24.2%);与升主动脉组比,复合桥组桡动脉桥失败率更低,但两组间差异无统计学意义(27.8%vs.10.0%,P=0.096)。术后1年桡动脉桥失败改善至16例(16.1%)。与桡动脉桥通畅患者比,围术期桡动脉桥失败患者术中桡动脉桥搏动指数较高,桡动脉桥平均血流量较低(P均<0.05);术后1年桡动脉桥失败患者术中桡动脉桥搏动指数较高,桡动脉桥远端吻合在右冠状动脉患者占比较高(P均<0.05)。结论:桡动脉桥近端吻合在升主动脉或其他桥血管上并不影响其围术期通畅性。围术期失败的桡动脉桥术后1年有再通现象。术后1年失败患者术中桡动脉桥搏动指数较高,桡动脉桥远端吻合在右冠状动脉患者占比较高。Objectives:The aim of this study was to assess the influence of graft anastomosis strategies of radial artery on the flow characteristics and early patency in coronary artery bypass grafting(CABG).Methods:Present study enrolled 99 patients(92 males,7 females,aged[57.2±8.7]years),who underwent isolated CABG using a radial artery(RA)graft from January 2019 to December 2021 in our department.The RA was proximally anastomosed to the aorta in 79 patients(group 1)and to another graft as a composite graft in 20 patients(group 2).The intraoperative flow characteristics were evaluated with the transit time flow measurement(TTFM),and the graft patency was assessed by computed tomography coronary angiograms perioperatively and at 1year after operation respectively.Results:Baseline characteristics were similar between the two groups(all P>0.05).There was no perioperative death.Incidence of minimally invasive cardiac surgery for CABG(MICS CABG)and mean flow(MF)of RA grafts were both higher in group 2 than in group 1(all P<0.05).Perioperative RA graft failure rate was 24.2%(n=24),which tended to be lower in group 2 than in group 1(10.0%vs.27.8%,P=0.096).CT angiography showed that RA graft failure reduced to 16.1%at one year after operation.Compared to patency group,patients with failure RA grafts perioperatively had higher pulse index(PI)and lower intraoperative MF(all P<0.05).Patients with failure RA grafts at one year after operation had higher PI and more bypassed to the right coronary artery(RCA)target territories of RA grafts(all P<0.05).Conclusions: RA proximal anastomosis to the aorta or to another graft dose not affect the perioperative patency inCABG. Some RA graft that failed perioperatively might recanalize at one year after operation. High intraoperative PI andbypassed to RCA of RA grafts may be predictors of graft failure at one year after operation.

关 键 词：冠状动脉旁路移植术 桡动脉 瞬时血流测定 

分 类 号：R54[医药卫生—心血管疾病]