不同乳内动脉游离方法在冠状动脉旁路移植中的应用效果比较  

Comparison of the Safety and Long Term Prognosis of Coronary Artery Bypass Transplantation by Different Methods of Free Mammary Artery

作　　者：张俊伟[1] 马俊贤[2] 王永生[1] ZHANG Junwei;MA Junxian;WANG Yongsheng(Department of Cardiovascular Surgery,the First Affiliated Hospital of Henan University of Science and Technology,luoyang 471000,China;Department of Obstetrics and Gynecology,the First Affiliated Hospital of Henan University of Science and Technology,luoyang 471000,China)

机构地区：[1]河南科技大学第一附属医院心脏大血管外科,河南洛阳471000 [2]河南科技大学第一附属医院妇产科,河南洛阳471000

出　　处：《河南医学研究》2024年第6期1026-1030,共5页Henan Medical Research

摘　　要：目的探究不同乳内动脉游离方法下冠状动脉旁路移植的安全性及术后远期预后。方法回顾性选取2016年1月至2020年3月在河南科技大学第一附属医院接受冠状动脉旁路移植术的患者117例,根据患者乳内动脉游离方式分组,A组患者接受带蒂法游离胸廓内动脉,B组患者接受骨骼化法游离胸廓内动脉。对两组患者术中临床指标、围手术期指标及术后并发症发生情况进行记录。对患者进行3 a随访,记录两组患者随访期内心绞痛分级情况及不良心血管事件发生情况。结果两组患者的手术时间、远端吻合口数、左侧乳内动脉流量、左侧乳内动脉搏动指数、右侧乳内动脉流量、右侧乳内动脉搏动指数差异无统计学意义(P>0.05)。两组患者的呼吸机辅助时间、左心室射血分数、左心室舒张末期内径、术后切口疼痛情况比较,差异无统计学意义(P>0.05)。B组患者的术后胸腔积液量少于A组,ICU停留时间短于A组(P<0.05)。B组患者术后总并发症发生率低于A组(P<0.05)。随访期止时,B组患者高等级心绞痛发生率低于A组(P<0.05)。两组患者不良心血管事件发生率差异无统计学意义(P>0.05)。结论在冠状动脉旁路移植手术中,骨骼化法游离胸廓内动脉在术后并发症发生率、胸腔积液量、ICU停留时间以及高等级心绞痛的发生率等方面表现优于带蒂法游离胸廓内动脉。Objective To compare the safety and long-term prognosis of coronary artery bypass transplantation by different methods of mammary artery free transplantation.Methods A total of 117 patients who received coronary artery bypass grafting in First Affiliated Hospital of Henan University of Science and Technology from January 2016 to March 2020 were retrospectively selected,and the patients were divided into groups according to the mode of intramastric artery free:group A underwent pedicle method to free internal thoracic artery,group B underwent skeletal method to free internal thoracic artery.The intraoperative clinical indexes,perioperative indexes and postoperative complications of the two groups were recorded.Patients were followed up for three years,and the incidence of angina pectoris and adverse cardiovascular events were recorded in both groups during the follow-up period.Results There was no statistically difference in surgical time,number of distal anastomoses,left internal mammary artery flow,left internal mammary artery pulsatility index,right internal mammary artery flow,and right internal mammary artery pulsatility index between the two groups of patients(P>0.05).There was no statistically difference between the two groups of patients in terms of ventilator-assisted time,left ventricular ejection fraction,left ventricular end diastolic diameter,and postoperative incision pain(P>0.05).The postoperative pleural effusion in group B patients was less than that in group A,and the ICU stay time was shorter than that in group A(P<0.05).The overall incidence of postoperative complications in group B patients was lower than that in group A(P<0.05).At the end of the follow-up period,the incidence of high-grade angina in group B was lower than that in group A(P<0.05).There was no statistically significant difference in the incidence of adverse cardiovascular events between the two groups of patients(P>0.05).Conclusion The free internal thoracic artery performed better than the free internal thoracic artery with pe

关 键 词：冠状动脉旁路移植术 乳内动脉 带蒂法 骨骼化法 胸廓内动脉 安全性 

分 类 号：R543.3[医药卫生—心血管疾病]