| 双侧乳内动脉搭桥术的疗效及影像学随访:基于64例60~75岁糖尿病患者 |
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| 作者姓名： | 郭义龙 王小啟 何书武 舒悦 王天光 陈泽伦 |
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| 作者单位： | 1.海南医学院第二附属医院心血管外科，海南 海口 5703112.阜外心血管病医院心血管外科，北京 100037 |
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| 基金项目： | 海南省自然科学基金818QN319 |
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| 摘 要： | 目的 探讨老年（60~75岁）糖尿病患者接受双侧乳内动脉（BIMA）搭桥手术的早期（3月）疗效及影像学随访结果，总结针对该类患者的诊疗经验。 方法 回顾性分析2015年12月~2017年8月于我科接受BIMA搭桥术的64例老年患者，将其按是否患有糖尿病分为糖尿病组和非糖尿病组。糖尿病组36例，男性25例，女性11例，年龄62.83±2.60岁；非糖尿病组28例，男性23例，女性5例，年龄62.29±1.76岁。分析两组患者术前一般情况、术中资料（主动脉阻断时间、体外循环时间、手术时间等）、术后常见并发症的发生率、影像学随访结果等资料，探讨该类患者的早期手术疗效，总结诊疗经验。 结果 糖尿病组“左主干+三只血管病变”的患病率及术前糖化血红蛋白水平均高于非糖尿病组（P=0.025、0.001）。两组患者在骨骼化获取乳内动脉例数、手术时间、体外循环时间、主动脉阻断时间、乳内动脉桥的即刻血流量及搏动指数（PI值）等方面差异无统计学意义（P > 0.05）。两组患者胸部切口愈合不良、乳糜胸等常见并发症的发生率差异无统计学意义（P > 0.05）；4例患者合并术后胸部切口并发症，其术前的糖化血红蛋白水平高于其他患者（P < 0.001）。冠脉CT血管造影结果显示，两组患者术后早期桥血管的闭塞率差异无统计学意义（P > 0.05）。 结论 相较于非糖尿病的老年患者而言，老年糖尿病患者的冠脉病变较重，但BIMA搭桥术的手术难度无增加，在适当治疗的基础上可获得满意的早期疗效，冠脉CTA作为该类患者早期的随访方法结果较满意。
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| 关 键 词： | 老年患者 糖尿病 双侧乳内动脉搭桥术 冠状动脉旁路移植术 冠状动脉血管造影 早期疗效 |
| 收稿时间： | 2020-03-11 |
Efficacy of bilateral internal mammary arterial grafting for elderly diabetic patients and imaging follow-up |
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| Authors: | Yilong GUO Xiaoqi WANG Shuwu HE Yue SHU Tianguang WANG Zelun CHEN |
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| Affiliation: | 1.Department of Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou 570311, China2.Department of Cardiovascular Surgery, Fuwai Hospital, Beijing 100037, China |
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| Abstract: | Objective To explore the short-term (3 months) results of bilateral internal mammary artery (BIMA) grafting in elderly diabetic patients (60-75 years old). Methods From December 2015 to August 2017, 64 elderly patients who underwent BIMA grafting in our department were enrolled. They were divided into two groups: diabetic group and non-diabetic group. The diabetic group had 36 cases, including 25 males, 11 females, with an average age of 62.83±2.60 years old. Non-diabetic group had 28 cases, including 23 males and 5 females, with an average age of 62.29±1.76 years old. The clinical records, intra-operative data (aortic clamp time, cardiopulmonary bypass time, operation time, etc.), short-term complications, and imaging follow-up data of these patients were retrospectively analyzed. Results The incidence rate of left main + triple-vessel disease and preoperative HbA1c level of diabetic group were higher than those of non-diabetic group (P=0.025, 0.001). The differences of the internal mammary artery harvest technique, operation time, aortic clamp time, cardiopulmonary bypass time as well as the flow and pulsatility index of internal mammary artery grafts between two groups were not significant (P > 0.05). The difference of sternal wound complications and other common complications between these groups was not significant (P > 0.05). Four patients suffered sternal wound complications. The preoperative HbA1c level of them was significantly higher than the other's (P < 0.001). The difference of grafts occlusion between two groups was not significant (P > 0.05), according to the results of coronary CTA three months after operation. Conclusions Compared with the elderly patients without diabetes mellitus, the coronary artery lesions in the elderly (60-75 years old) diabetic patients are more serious. However, the difficulty of BIMA grafting for them are not increased. Satisfactory short-term results could be achieved on the basis of appropriate treatment. Coronary CTA as a follow-up method for these patients achieves satisfactory results. |
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