冠状动脉旁路移植术后远期左乳内动脉桥血管血流储备影响因素分析

目的:测定冠状动脉旁路移植(CABG)术后左侧乳内动脉(LIMA)桥血管血流储备(CFR),分析CABG术后远期LIMA桥血管CFR的影响因素。方法:纳入以LIMA为左前降支(LAD)桥血管的CABG术后患者107例,CABG术后时间(17.58±14.45)个月,采用经胸多普勒超声心动图测定LIMA桥血管CFR及吻合口近端LAD的CFR。结果:所有患者测得桥血管CFR,CFR_(桥血管)为2.70±0.82,28例患者可见吻合口近端LAD逆向血流,CFR_(LAD)为2.10±0.97。CFR_(桥血管)2.5患者44例(41.12%)。CFR_(桥血管)2.5组患者劳力性胸痛发生率明显高于CFR_(桥血管)≥2.5组患者(29.55%∶7.94%,P=0.005)。合并高血压患者桥血管CFR明显低于无高血压患者[(2.52±0.74):(3.02±0.86),P=0.002],合并糖尿病患者桥血管CFR明显低于无糖尿病患者[(2.39±0.65):(2.85±0.86),P=0.003]。多因素分析显示高血压、糖尿病为桥血管CFR独立预测因素(P0.05)。结论:高血压、糖尿病是CABG术后远期LIMA桥血管CFR独立预测因素,CFR_(桥血管)2.5患者劳力性胸痛发生率高。     

桡动脉、乳内动脉、大隐静脉中RhoA/ROK mRNA 的表达与心血管危险因素的相关性

目的 探讨桡动脉（RA）、乳内动脉(IMA)、大隐静脉(GSV) 中RhoA/Rho 激酶（ROK）mRNA表达的差异，以及心血管危险因素对其表达的影响。方法 取14例CABG术中废弃的配对RA、IMA、GSV各5～10 mm，用RT-PCR检测RhoA/ROK mRNA的水平。采用多元逐步回归分析心血管危险因素对3种桥血管中RhoA/ROK表达的影响。结果 ①RT-PCR:IMA与GSV比较，RhoA和ROK mRNA表达的水平无显著差异；但RA中RhoA 和ROK mRNA表达的水平显著高于IMA（P<0.01，P<0.05）。②多元逐步回归分析显示，GSV中RhoA和ROK mRNA表达的水平与糖化血红蛋白呈显著正相关（r=0.642、r=0.692,P<0.05）。3种血管中RhoA、ROK mRNA的表达与年龄、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白A1、载脂蛋白B、C反应蛋白、胰岛素、胰岛素抵抗及体质量指数均无显著相关。结论 ①RA、IMA、GSV管壁中RhoA/ROK mRNA的表达有差异，RA中Rho/ROK mRNA的表达明显强于IMA。②糖化血红蛋白可影响GSV 中RhoA/ROK mRNA的表达。     

蛋白激酶Cα-胞外调节蛋白激酶1/2与人气道平滑肌细胞中周期蛋白D1及P21cip1 表达的关系

目的 探究蛋白激酶C(PKC)α-胞外调节蛋白激酶(ERK)1/2级联对支气管哮喘(简称哮喘)患者血清被动致敏的人气道平滑肌细胞(HASMC)周期蛋白D1(cyclinD1)、周期蛋白依赖性激酶(CDK)抑制剂P21 cipl的调节作用及细胞增殖的影响.方法 用含10%哮喘患者血清的DMEM培养基被动致敏HASMC后,按随机数字表法分为对照组、12-肉豆蔻酰-13-乙酸佛波酯(PMA)处理组、PMA+PKCα错配寡核苷酸组、PMA+PKCα反义寡核苷酸组以及PMA+U0126组,每组4个样本.用Western blot方法检测各组细胞磷酸化PKCα(p-PKCα)、ERK1/2、磷酸化ERK1/2(p-ERK1/2)、cyclinD1和P21 cipl的蛋白表达水平,用流式细胞术和四甲基偶氮唑盐(MT)法检测HASMC增殖.结果 PMA处理组p-PKCα水平、ERK1/2和p-ERK1/2蛋白水平高于对照组,cyclinD1、P21 cipl表达明显强于对照组(相对于各对照组的A值分别为2.10±0.29、1.67±0.19、2.20±0.27、1.99±0.22和3.11±0.29,均P＜0.05),HASMC的增殖[S期细胞比例为(30.3±2.4)%,A490值为0.80±0.06]高于对照组[S期细胞比例为(13.9±2.6)%,A490值为0.41±0.04],均P＜0.05;PMA+PKCα反义寡核苷酸组中p-PKCα水平低于PMA处理组,ERK1/2和p-ERK1/2表达明显弱于PMA处理组,cyclinD1和P21 cipl 表达也明显低于PMA处理组(相对于各对照组的A值分别为1.23±0.19、1.34±0.18、1.52±0.20、1.45±0.18和1.49±0.18,均P＜0.05),HASMC的增殖显著下降[S期细胞比例为(21.2±2.8)%,A490值为0.51±0.04;q值分别为6.07,12.63;均P＜0.05];同样与PMA处理组相比,PMA+U0126组中p-PKCα水平无明显改变(A值为1.99±0.18,q=0.94,P＞0.05),但ERK1/2、P-ERK1/2的表达,cyclinD1和P21 cipl的表达明显低于PMA处理组A值分别为0.95±0.21、1.15±0.19、1.37±0.15和1.96±0.21,均P＜0.05),HASMC的增殖显著下降[S期细胞比例为(22.0±3.2)%,A 490值为0.49±0.03;q值分别为5.51、13.45,均P＜0.05].结论 ERK1/2是PKCα的下游信号分子,PKCα-ERK1/2级联参与了PMA所诱导的哮喘患者血清被动致敏的人气道平滑细胞cyclinD1、P21 cipl的表达上调及细胞增殖.     

全动脉化冠状动脉旁路移植74例

目的:介绍全动脉化冠状动脉旁路移植（CABG）的早期效果和经验。方法:74例全动脉化CABG的患者。74例患者分别在体外循环（CPB）和非CPB下行CABG。应用左乳内动脉（IMA）1例,左IMA加单挠动脉（RA）14例,左IMA加双RA 54例,双IMA加双RA 3例,双RA 2例。人均搭桥4.7（17）支,序贯吻合66例,“Y”和“T”型吻合分别为15和6例。结果:围手术期无死亡。本组患者随访518（平均12.2）个月,均恢复良好,无心绞痛症状再发。多普勒和16排CT示血管桥无狭窄通畅。结论:全动脉化CABG取得好的早期效果,是一种值得积极推广的方法。     

血管紧张素Ⅱ受体1型-钙调神经磷酸酶信号通路对乳鼠肥大心室肌细胞L型钙离子流的调控作用

目的:探讨血管紧张素Ⅱ受体1型(AT1R)-钙调神经磷酸酶(CaN)信号通路对乳鼠肥大心室肌细胞L型钙离子通道电流(I_(Ca-L))和动作电位时程(APD)的调控作用。方法:分离获得1 d龄SD乳鼠心室肌细胞,分为4组,对照组不予干预;苯肾上腺素(PE)组常规培养1 h后加入PE(终浓度0.1 mmol/L)干预24 h;氯沙坦(Los)+PE组先予Los(终浓度1μmol/L)干预1 h,再予PE干预24 h;环孢素A(CsA)+PE组先予CsA(终浓度0.25μg/mL)干预1 h,再予PE干预24 h。实时荧光定量聚合酶链反应检测肌球蛋白重链β(β-MHC)的mRNA表达水平。Western blot检测CaN A亚基β亚单位(CaNAβ)蛋白表达水平。全细胞膜片钳技术检测细胞膜I_(Ca-L)和单细胞APD。结果:PE组β-MHC的mRNA表达水平和CaNAβ的蛋白表达水平均高于对照组;I_(Ca-L)电流密度峰值绝对值[(-18.23±1.44)pA/pF对(-10.78±1.87)pA/pF]、50%APD[(25.7±2.4)ms对(15.3±3.0)ms]和90%APD[(197.6±10.6)ms对(91.8±21.3)ms]均高于对照组(P均0.05)。Los+PE组β-MHC的mRNA表达水平和CaNAβ的蛋白表达水平均低于PE组;I_(Ca-L)电流密度峰值绝对值[(-14.02±1.51)pA/pF]、50%APD [(20.4±2.9)ms]和90%APD [(128.7±18.5)ms]均低于PE组(P均0.05)。CsA+PE组β-MHC的mRNA表达水平和CaNAβ的蛋白表达水平均低于PE组;I_(Ca-L)电流密度峰值绝对值[(-12.19±1.09)pA/pF]、50%APD [(22.7±1.9)ms]和90%APD [(121.7±15.0)ms]均低于PE组(P均0.05)。结论:AT1R-CaN信号通路参与乳鼠肥大心室肌细胞I_(Ca-L)和APD的调控。     

糖尿病患者冠状动脉旁路移植术后胸痛复发特征的分析

目的:分析糖尿病患者行冠状动脉旁路移植术(CABG)后胸痛复发的临床特征和桥血管病变特点。方法:连续入选2002年11月至2016年12月,北京安贞医院心内科,以CABG术后再发胸痛为主要原因首次住院并完成冠状动脉造影的患者797例,其中男性627例,女性170例。按照患者有无糖尿病分为糖尿病组(301例)和非糖尿病组(496例)。记录入选病例的基本临床信息和实验室检查指标。根据冠状动脉造影结果记录血管病变程度及病变部位。分析两组既往病史、造影距离CABG时间、桥血管的病变程度和病变部位的差异。结果:糖尿病组男性比例低于非糖尿病组(P=0.005),高血压比例高于非糖尿病组(P=0.004)。比较两组冠状动脉造影距离CABG的时间,糖尿病组6个月(P=0.003)及6个月~1年(P=0.029)的比例均低于非糖尿病组,1~5年的比例高于非糖尿病组(P=0.018)。糖尿病组红细胞计数(P=0.027)、血肌酐(P=0.006)、尿酸(P=0.004)以及CDL-C(P=0.009)均低于非糖尿病组,空腹血糖高于非糖尿病组(P0.001)。两组乳内动脉桥、静脉桥的病变程度和病变部位未见显著差异。结论:有无糖尿病在乳内动脉桥和静脉桥病变程度和部位方面无明显差异。糖尿病患者CABG后复发胸痛多出现在术后1~5年,糖尿病规范治疗对于改善CABG的预后具有重要意义。     

冠状动脉旁路移植术血管桥痉挛处理进展

随着冠状动脉搭桥手术 (CABG)趋于成熟 ,内乳动脉 (IMA)、桡动脉 (RA)、大隐静脉 (SV)等血管桥广泛采用 ,取材过程中 ,压力扩张、溶液冲洗、血管桥营养血管破坏等均能引起内皮细胞损伤。血管内皮细胞释放内皮源性一氧化氮 (NO)、前列环素 (PGI2 )、内皮依赖性超级化因子 (EDHF)等血管活性物质参与内皮增生、炎症反应、免疫调节及血管平滑肌张力调节。内皮功能不全或内皮细胞损伤引起NO、PGI2、EDHF生成及释放减少 ,术中及术后血管桥痉挛经常发生 ,从而引起心肌血流量减少 ,血栓形成 ,降低血管桥近期及远期通畅率。因而 ,深入理…     

钙敏感受体对血管紧张素Ⅱ诱导大鼠心肌细胞肥大的作用

目的 观察钙敏感受体(CaSR)在血管紧张素Ⅱ(Ang Ⅱ)诱导心肌细胞肥大中的作用和可能机制.方法 用Ang Ⅱ处理原代新生大鼠心室肌细胞复制心肌肥大细胞模型;用CaSR激动剂氯化钆(GdCl3),GdCl3+蛋白激酶C(PKC)通路阻断剂(Ro318220)处理AngⅡ诱导的肥大心肌细胞分别作为GdCl3、Ro318220组.通过苏木素-伊红染色(HE)法测定细胞直径,考马斯亮蓝蛋白试剂盒测定蛋白含量来评价细胞肥大的情况;利用激光共聚焦显微镜检测心肌细胞内钙浓度([Ca2+]i;Western blot法检测CaSR和PKC通路的蛋白表达.结果 ①与对照组(0.1263±0.0443)比较,Ang Ⅱ组(0.1963±0.0375)和GdCl3组(0.2778±0.0564)CaSR蛋白表达明显增加(P均＜ 0.05),且GdCl3组明显高于AngⅡ组(P＜0.05).②与对照组(222.70±22.09)比较,Ang Ⅱ组(392.16±36.85)和GdCl3组(502.60±44.21)心肌细胞内[Ca2+]i显著增加(P均＜0.05);与Ang Ⅱ组比较,GdCl3组[Ca2+]i显著增加(P＜0.05).③与对照组比较,Ang Ⅱ可诱导心肌细胞肥大,GdCl3可促进Ang Ⅱ的诱导作用,而Ro318220可抑制GdCl3的作用;④与对照组(0.27±0.07、0.69±0.06、0.87±0.04)比较,Ang Ⅱ组PKCα、PKCε和PKCδ蛋白表达明显增加(0.60±0.16、1.02±0.13、1.20±0.18,P均＜0.05),GdCl3组PKCα、PKCε蛋白表达明显增加(0.82±0.16、1.34±0.12,P均＜0.05);与Ang Ⅱ组比较,GdCl3组PKCα、PKCε蛋白表达明显增加(P均＜ 0.05);与GdCl3组比较,Ro318220组PKCα、PKCε蛋白表达(0.41±0.10、0.85±0.14)明显减少(P均＜ 0.05).结论 PKC通路参与CaSR激活促进心肌细胞肥大的信号转导.     

冠状动脉旁路手术中动脉材料的选择与应用

目的 在冠状动脉旁路手术(CABG)中寻求动脉材料作旁路移植，减少因大隐静脉桥(SVG)阻塞对远期通畅率的影响。方法 34例冠心病患者以乳内动脉(IMA)和桡动脉(RA)作为血管桥行CABG，采用不接触血管技术制备动脉桥，应用药物防止动脉痉挛。结果 取乳内动脉35根，桡动脉20根，大隐静脉11根，平均移植血管1．94支，死亡1例，手术死亡率2．9％。结论 使用动脉材料行旁路移植术安全有效，预计能保持移植血管长期通畅。     

蛋白激酶C-核因子κB信号转导通道对人肺动脉平滑肌细胞增殖和血管内皮生长因子表达的影响

目的　探讨蛋白激酶C(PKC) 核因子κB(NF κB)信号转导通道对人肺动脉平滑肌细胞 (HPASMCs)增殖和血管内皮生长因子 (VEGF)表达的影响。方法　体外培养HPASMCs ,用工具药PKC激活剂 12 肉豆蔻酰 13 乙酸佛波酯 (PMA)和NF κB抑制剂二硫代氨基甲酸吡咯烷 (PDTC) ,将HPASMCs分为对照组、PMA组和PMA PDTC组在常氧和缺氧条件下培养。逆转录 聚合酶链反应 (RT PCR)检测VEGFmRNA表达 ,Westernblot法检测VEGF和NF κB的抑制蛋白IκBα蛋白表达 ,免疫细胞化学法检测NF κBp6 5的表达和定位 ,流式细胞术检测细胞周期时相分布。结果　( 1)NF κBp6 5胞核染色阳性率、IκBα蛋白相对表达量及细胞周期G2 /M % :常氧或缺氧PMA组与相应对照组、PMA PDTC组比较差异均有显著性 (P均 <0 0 5 ) ;缺氧PMA组与常氧PMA组比较差异有显著性 (P <0 0 5 )。 ( 2 )VEGFmRNA和蛋白表达 :常氧对照组、PMA组、PMA PDTC组组间差异均无显著性 (P均 >0 0 5 ) ;缺氧PMA组均高于缺氧对照组、缺氧PMA PDTC组、常氧PMA组 ,差异均有显著性 (P均 <0 0 5 )。 ( 3)缺氧PMA组NF κB胞核染色阳性率、VEGF蛋白相对表达量、G2 /M %之间均呈正相关 (r =0 5 87～ 0 710 ,P均 <0 0 5 )。结论　常氧培养HPASMCs存在PKC NF κB信号转导通道 ;     

Up-regulation of CPI-17 phosphorylation in diabetic vasculature and high glucose cultured vascular smooth muscle cells

OBJECTIVE: Contractile responses are significantly increased in vascular smooth muscle tissues isolated from type 2 diabetic db/db mice (hyperreactivity). However, the molecular mechanisms underlying this hyperreactivity are largely unknown. The current study investigates the roles of RhoA, ROCK (rho kinase), PKC (protein kinase C), and CPI-17 (protein kinase C-potentiated phosphatase inhibitor of 17 kDa), molecules shown to play pivotal physiological roles regulating smooth muscle contraction, in diabetes-associated vascular smooth muscle hyperreactivity. METHODS: Experiments utilized db/db mouse mesenteric arteries and aortas and primary rat aortic smooth muscle cells (VSMCs) cultured in high or normal glucose. RhoA, ROCK, and CPI-17 protein expression and activity were determined by immunoblotting for total or phosphorylated proteins. RhoA activity was determined by subcellular fractionation and pull-down assays. Isometric contractions were determined using isolated mesenteric artery strips. RESULTS: Active phosphorylated CPI-17 and total and active membrane-bound RhoA were significantly increased in db/db mouse mesenteric arteries and aortas. High glucose time-dependently activated RhoA, ROCK, and CPI-17 in VSMCs. Moreover, inhibiting either RhoA with C3 exoenzyme or ROCK with Y-27632 or H-1152 for 30 min diminished high glucose-induced CPI-17 phosphorylation. Inhibiting protein kinase C (PKC) with GF109203X for 30 min did not inhibit high glucose-induced CPI-17 phosphorylation. Interestingly, when added at the same time as high glucose for a total of 48 h, GF109203X diminished high glucose-induced RhoA and ROCK activation as well as CPI-17 phosphorylation, suggesting PKC is required for high glucose-induced RhoA/ROCK activation and consequently CPI-17 phosphorylation. Importantly, in isolated db/db mouse mesenteric arteries, inhibiting ROCK with Y-27632 or H-1152 significantly alleviated the contractile hyperreactivity in response to phenylephrine or high potassium. CONCLUSIONS: Diabetes and high glucose activate RhoA, ROCK, and CPI-17, which in turn contribute to diabetic vascular smooth muscle hyperreactivity.     

Prevention of radial artery graft spasm: a survey of Canadian surgical centres

BACKGROUND: The radial artery (RA) is used as an alternative conduit to the traditional saphenous vein bypass graft in some cardiac surgery centres. Despite limited clinical trial data, many centres appear to be using routine drug therapy to prevent spasm of the RA graft in the immediate and late postoperative period. OBJECTIVES: To determine the proportion of patients in Canadian cardiac surgery centres having RA bypass grafts and the percentage of patients routinely receiving drug therapy to prevent spasm of these grafts. METHODS: A questionnaire was sent to all cardiac surgery centres in Canada requesting data for the year 2000 on the total number of bypass surgery operations and the number of patients having RA bypass grafts. Information on approaches taken toward prophylaxis against spasm of RA grafts was also requested. RESULTS: The use of RA grafts ranged between 1% and 50%. Twenty-five of 27 centres used antispasm prophylaxis with calcium channel blockers with or without long acting nitrates both in the intensive care unit and on the surgical ward. Calcium channel blockers were prescribed routinely in all 25 centres with 12 centres also using long acting nitrates. Only two centres routinely continued nitrates on the ward. The duration of antispasm therapy varied from several weeks up to six months. CONCLUSIONS: Prophylaxis against spasm of RA grafts is practised in over 95% of Canadian surgical centres despite limited clinical outcome data to support this practice.     

冠状动脉搭桥术后静脉桥狭窄和新生易损斑块形成机制的研究进展

冠状动脉搭桥术术后发生桥血管病变是一种常见的现象,血栓形成、内皮功能障碍、血管痉挛和氧化应激是导致病变的重要机制。相比于动脉桥,静脉桥更易于发生病变,这与静脉本身的解剖形态和功能特征有着很大的关系。急性血栓形成、血管内膜增生和易损斑块形成是静脉桥不同时期发生病变的重要机制。使用抗血小板和调脂药物等冠心病二级预防药物有助于提高桥血管的开通率。寻找桥血管病变的预测因子及相关基因通路有望从细胞及分子学水平为静脉桥疾病提供新的研究方向。本文拟对冠状动脉搭桥术后发生静脉桥狭窄和新生易损斑块病变形成机制的研究进展作一综述。     

Does coronary artery bypass surgery restore normal maximal coronary flow reserve? The effect of diffuse atherosclerosis and focal obstructive lesions

Aortocoronary vein bypass surgery might not restore normal maximal coronary flow reserve to bypassed coronary vessels because residual diffuse coronary atherosclerosis might limit maximal hyperemia. To investigate the effect of diffuse atherosclerosis and a focal stenosis at the graft-coronary anastomosis, we measured coronary flow reserve with an extensively validated subselective Doppler catheter in 24 patients with 35 bypass grafts perfusing angiographically normal coronary vessels. The Doppler catheter was positioned in the midportion of the graft, and coronary flow reserve was measured as the peak/resting velocity ratio after selective graft injection of a maximally vasodilating dose of papaverine. Luminal dimensions of the bypass graft, graft-coronary insertion, and bypassed coronary vessel were measured by quantitative coronary angiography (Brown/Dodge method). Measurements of coronary flow reserve and coronary dimensions of vein bypass grafts were compared with similar measurements obtained from 13 patients with normal coronary vessels and normal myocardium. Seventeen of the 35 bypass grafts perfused unobstructed coronary-vein graft anastomoses (less than 50% area stenosis) and normal myocardium. The coronary flow reserve of these 17 bypass grafts was normal (5.0 +/- 0.4, mean +/- SEM) and not significantly different from that measured in normal arteries (5.1 +/- 0.6), even though the cross-sectional area of the native coronary artery just distal to the bypass insertion was 40% smaller than in matched normal vessels. Bypass grafts perfusing hypertrophied (n = 2) or infarcted (n = 6) myocardium had significantly reduced coronary flow reserve compared with normal vessels (2.7 +/- 0.3; p less than .01), even when the infarcted wall had only minimal hypokinesis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Complete arterial revascularization in the diabetic patient--early postoperative results

BACKGROUND: The prognostic benefit of arterial grafts appears to be particularly high in patients with diabetes mellitus, but has been limited by availability of grafts and sternal complications. Complete arterial coronary artery bypass grafting (caCABG) using skeletonized grafts, radial arteries (RA) and the T-graft approach may reduce the perioperative risk particularly in the diabetic patient. METHODS: The perioperative data of 174 diabetic (group I) and 402 non-diabetic patients (group II) who underwent caCABG were studied retrospectively. The operations were performed using bilateral internal thoracic arteries (ITA) (I: 20%; II: 21%; ns) or ITA and RA (I: 80%; II: 79%; ns). Diabetic patients presented with a higher incidence of 3-vessel disease (I: 93%; II: 83%; p<0.05) and a lower left ventricular ejection fraction (I: 55+/-16%; 11:60+/-16%; p<0.05). RESULTS: No differences were found regarding need of intraaortic balloon pump (I: 1.7%; II: 2.7%; ns), incidence of myocardial infarction (I: 1.2%; II: 1.7%; ns) and sternal complications (I: 2.3%; II: 1.0%; ns). In-hospital mortality was 1.7%(I) versus 2.2% (II) (p = ns). CONCLUSIONS: Using skeletonized arterial grafts and the T-graft approach, caCABG in diabetic patients is as safe as in non-diabetics. With the RA as a second graft, bilateral ITA harvesting is avoidable.     

Evaluation of coronary bypass graft patency by ultrafast computed tomography

A noninvasive technique for determining bypass graft patency is greatly needed. To determine if bypass graft patency could be accurately assessed with ultrafast computed tomography (CT) following an intravenous contrast injection, ten patients with 21 coronary bypass grafts were studied. All patients had cardiac catheterization and ultrafast computed tomographic studies within one month of each other. The sensitivity of detecting angiographically open grafts with ultrafast CT was 94.1% (16/17), specificity of detecting angiographically closed grafts was 100% (4/4), and accuracy was 95.2% (20/21). These preliminary results in a small clinical series indicate that ultrafast CT may be a useful, minimally invasive technique for evaluating coronary bypass graft patency.     

糖尿病患者冠状动脉旁路移植术后的生命质量评价

目的 运用西雅图心绞痛问卷和杜克活动问卷对冠状动脉旁路移植术后DM患者的生命质量进行评价。方法对2001年1月至2002年1月于北京大学人民医院心脏外科接受冠状动脉旁路移植手术的患者273例进行生命质量问卷调查,对问卷进行信度和效度的评价。结果共有DM患者52例;两个生命质量问卷的信度分析结果内部一致性系数分别为0．81、0．75,结构效度分析结果显示存在不同程度的统计学相关性。DM组与非DM组的西雅图心绞痛问卷总分及各亚组得分均不存在统计学差异,两组间杜克活动问卷总分、VO2PEAK得分、MET得分均存在统计学差异（P均＜0．05）。结论糖尿病可能是影响冠状动脉旁路移植术后患者生命质量的因素。     

正-逆灌并选择性桥血管灌注技术在重症冠状动脉旁路移植术中的价值

目的 总结和分析顺-逆灌并选择性桥血管灌注技术在重症冠状动脉旁路移植术（coronary artery bypass grafting,CABG）中的应用价值.方法 回顾分析2010年6月至2011年12月河南省人民医院收治的重症冠状动脉粥样硬化性心脏病（冠心病）患者152例的临床资料.术前患者均常规行冠状动脉造影术,其中合并左主干病变46例,狭窄程度均大于70％,左前降支完全闭塞51例,前降支及右冠状动脉均完全闭塞29例,三支血管弥漫性病变并血管细小55例;所有手术均在体外循环下进行,术中均经冠状动脉顺灌加冠状静脉窦逆灌并选择性桥血管灌注进行心肌保护.结果 所有患者术中转流平稳,150例自动复跳,2例出现心室颤动,电除颤后顺利复跳,均顺利停机.术后5例出现低心排血量综合征,1例肾功能不全,2例低氧血症,经调整后均恢复,无死亡患者.结论 在重症CABG中,采用顺-逆灌并选择性桥血管灌注技术具有良好的心肌保护效果,能够明显改善患者的预后.     

单中心主动脉腔内隔绝术治疗胸降主动脉扩张性疾病的疗效评价

目的 评价主动脉腔内隔绝术治疗胸降主动脉扩张性疾病的近期和远期疗效及安全性.方法 选择沈阳军区总医院2002年4月至2013年10月行主动脉腔内隔绝术治疗胸降主动脉扩张性疾病的患者449例,其中男349例,女100例,年龄（54.3±11.9）岁.经股动脉切开植入覆膜支架封堵胸降主动脉夹层破口或隔绝胸主动脉瘤,主动脉造影确认疗效;合并严重冠状动脉狭窄的患者,于腔内隔绝术后3-7 d完成经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗.观察主动脉疾病患者PCI治疗的疗效.结果 主动脉腔内隔绝术操作成功率为100％,共植入416枚主体覆膜支架及56枚短体覆膜支架.43例患者完全封闭左锁骨下动脉开口,仅1例患者出现严重窃血综合征,行血管旁路移植术.34例患者行PCI治疗成功率为100％,对37支靶血管共植入45枚冠状动脉支架,无出血、心肌梗死等并发症.68例患者出现腔内隔绝术后综合征,76例患者术后有残余漏,其中11例因内漏明显同台或再次行手术治疗.住院期间主动脉破裂病死率为1.3％（6/449）.术后随访（68±29）个月,随访率为79.0％（350/443）.随访期间共死亡患者23例（6.6％）：明确主动脉血管破裂死亡4例,急性心肌梗死1例,脑出血4例,肾功衰竭死亡3例,多器官功能衰竭2例,恶性肿瘤4例,猝死5例（原因不明）.25例联合PCI治疗患者临床造影随访主要心血管事件发生率为8.0％（2/25）.结论 主动脉腔内隔绝术治疗胸降主动脉扩张性疾病近期及长期疗效好,并发症发生率低.合并冠状动脉粥样硬化性心脏病患者择期二次行PCI治疗安全可行,主要心血管事件发生率低.     

Factors affecting early graft patency after coronary grafts

From June 1984 to December 1987, an early postoperative angiographic study was performed in 247 patients who underwent isolated coronary artery bypass surgery. The average age of these patients was 58.6 years, range 31 to 75 years. Preoperatively 50.8% of patients had myocardial infarction and 43.2% of them had unstable angina before surgery. Early coronary artery bypass angiogram was performed in 683 grafts (2.76 grafts per patient): 74 internal mammary artery grafts and 609 saphenous vein grafts. The distribution, location and type of the stenosis, distal coronary artery diameter, segmental myocardial contractility, and distal angiographic coronary filling are analyzed with a matching statistical method. Multivariate analysis showed significant predictors of early graft occlusion to be right coronary and circumflex artery, poor or non visible distal angiographic filling, coronary arteries smaller than 1.5 mm. The univariate analysis associates as risk factors hypokinetic or akinetic territories and multiple stenosis coronary arteries. It can be concluded that the early angiographic study demonstrate that coronary arteries with multiple stenosis, poor distal angiographic filling, smaller than 1.5 mm in diameter, coronary arteries perfusing hypokinetic or akinetic territories and the right coronary and left circumflex artery grafts have significantly lower early cumulative patency rates.