冠状动脉旁路移植术后移植血管狭窄的危险因素分析

目的探讨冠状动脉旁路移植术（cABG）后移植血管狭窄的危险因素,为临床CABG术后移植血管狭窄的防治提供依据。方法回顾性分析1999年1月至2007年12月间197例cABG术后行选择性血管造影患者的临床资料,CABG术后按选择性血管造影检查是否有移植血管狭窄,将197例患者分为两组,狭窄组（n=87）,非狭窄组（n=110）。采用t检验、Χ^2检验和多因素logistic回归分析影响移植血管狭窄的危险因素。结果狭窄组的87例患者血管造影显示存在不同程度的移植血管狭窄,累及吻合口321处,其中远端吻合口305处,近端吻合口16处。单因素分析结果表明,合并糖尿病、血脂异常、远端吻合口吻合于右冠状动脉系统、靶血管狭窄〈70%、靶血管管径〈1．5mm、应用大隐静脉桥和非体外循环CABG等因素与CABG术后移植血管狭窄有关。logistic回归分析结果发现：糖尿病（OR=3．654）、血脂异常（OR=2．625）、靶血管狭窄〈70％（OR=1．763）、靶血管管径〈1．5mm（OR=1．337）、远端吻合口位于右冠状动脉系统（OR=1．694）和大隐静脉桥（OR=1．652）是CABG术后移植血管狭窄的独立危险因素。结论糖尿病、血脂异常、靶血管狭窄〈70％、靶血管管径〈1．5mm、远端吻合口位于右冠状动脉系统和大隐静脉桥是CABG术后移植血管狭窄的危险因素。     

冠状动脉旁路移植术后移植静脉再狭窄的研究进展

冠状动脉旁路移植术后移植静脉再狭窄是亟待解决的问题。移植静脉过度扩张导致管壁损伤,引起多种细胞因子和生长因子分泌,促进血管平滑肌细胞增生并向内膜迁移,进而细胞外基质沉积、血管壁重构和再塑,最终导致移植静脉再狭窄。血流动力学的改变和移植静脉管壁损伤是导致再狭窄的始动因素。防治方法主要有药物治疗、放射治疗、基因治疗和血管外支架治疗等,血管外支架联合基因治疗是一种前景看好的方法。     

冠状动脉旁路移植术后血管麻痹综合征的易发因素

目的探讨冠状动脉旁路移植术(CABG)后血管麻痹综合征的易发因素。方法24例CABG后发生血管麻痹综合征的患者,同时选入48例术后未发生血管麻痹的患者以1∶2的比例行病例对照研究。结果麻痹组术前左室射血分数(LVEF)<45%的占50.0%,明显高于对照组的10.4%(P<0.01);左室舒张末前后径(LVEDD)也明显大于对照组[(56.78±7.20)vs.(52.80±6.74)mm](P<0.05)。结论术前低LVEF(<45%)是CABG后血管麻痹综合征的易发因素。     

冠状动脉旁路移植术后的监护治疗

冠状动脉旁路移植术后的监护治疗张希涛刘岩肖锋颜钧１９９４年１０月～１９９６年８月，我院心脏外科ＩＣＵ病房共收治６７例冠状动脉旁路移植术后的患者，现将治疗体会报告如下。１临床资料与方法１．１一般资料本组共６７例，男５５例，女１２例。年龄４２～７４岁，平...     

冠状动脉旁路移植术后心房颤动的危险因素分析

目的为预测冠状动脉旁路移植术（CABG）后是否发生心房颤动（AF）,对其术前危险因素进行分析。方法收集安贞医院2007年9月至2008年4月226例体外循环冠状动脉旁路移植术（CABG）或非体外循环冠状动脉旁路移植术（OPCAB）患者的临床资料,根据术后3d内是否出现AF持续5min以上分为非AF组和AF组,分析两组患者超声心动图检查指标及术前一般临床资料。两组患者均采用胸骨正中切口,并在相同条件下完成手术。结果术后24例患者（10．6％）发生AF.AF组中左心房前后径〉35mm的患者高于非AF组[41．7％（10例）vs．22．3％（45例）,χ^2=4．380,P=0．036）];二尖瓣反流患者高于非AF组[37．5％（9例）vs．17．3％（35例）,χ^2=5．568,P=0．018）];左主干病变患者高于非AF组[33．3％（8例）vs．12．4％（25例）,χ^2=7．560,P=0．006];年龄AF组高于非AF组（65．7±9．5岁vs．60．1±10．1岁,t=-2．724,P=0．010）。两组患者单因素分析结果：高龄、二尖瓣反流、左心房大、左主干病变等手术前临床指标是术后发生AF的危险因素;手术后呼吸机使用时间（χ^2=4．190,P=0．040）,心电监护时间（χ^2=5．948,P=0．015）,住院费用（χ^2=4．110,P=0．043）等两组间比较差异有统计学意义。结论CABG后发生AF与高龄、二尖瓣反流、左心房增大、左主干病变等危险因素有关。临床资料、心电图、超声心动图检查等有助于预测CABG后是否发生AF,以使更好地预防和治疗,降低术后AF的发生率。     

桡动脉在冠状动脉旁路移植术中的应用

桡动脉（RA）作为冠状动脉旁路移植术（cABG）的移植血管已广泛应用，但在其获取、手部侧枝循环的评估、抗痉挛措施、靶血管选择、以及近端吻合口等方面尚未统一的认识。一般认为RA应当连同周围的伴行静脉血管一起获取并且优先用于严重狭窄（〉70％）的冠状动脉。RA近端可以吻合于升主动脉，或者与左侧或右侧乳内动脉一起构成复合移植血管。RA作为移植血管的通畅率主要取决于靶血管狭窄的严重程度和靶血管的位置，而不是取决于近端吻合于主动脉或是乳内动脉。尽管缺乏实验证据，许多研究者提倡预防性抗痉挛治疗。在全动脉化冠状动脉旁路移植的患者中应用RA取代右侧乳内动脉作为第二选动脉移植血管具有优势。     

非体外循环与体外循环冠状动脉旁路移植血管中远期通畅率比较

目的 比较非体外循环不停跳与体外循环冠状动脉旁路移植手术后中远期移植血管的通畅率.方法 对同一术者行冠状动脉旁路移植手术后5年以上病例50例.按手术方式分为两组.第1组采用传统体外循环下进行冠状动脉旁路移植(体外循环组,25例);第2组采用非体外循环不停跳技术进行冠状动脉旁路移植(非体外循环组,25例).对所有病例进行冠状动脉造影随访,比较两组移植血管的通畅情况.结果 两组均男21例,女4例.第1组手术年龄(55.4±8.9)岁;随访70～110个月,平均(86.52±12.48)个月;移植血管共83支,其中动脉移植血管41支,静脉移植血管42支,平均移植血管(3.32±0.63)支/例;随访移植血管通畅61支,狭窄6支,闭塞16支,动脉移植物通畅率为78.05%,静脉通畅率69.05%,总通畅率73.49%.第2组手术年龄(58.2±9.09)岁;移植血管共65支,其中动脉移植血管31支,静脉移植血管34支,平均移植血管(2.52±0.71)支/例,随访64～99个月,平均(82.68±12.48)个月;随访移植血管通畅47支,狭窄4支,闭塞14支,动脉移植物通畅率为74.19%,静脉通畅率70.59%,总通畅率72.31%.结论 非体外循环不停跳冠状动脉旁路移植手术移植血管中远期通畅率与传统体外循环手术一致,均可达到较好的中远期疗效.

Abstract：

Objective Off-pump coronary artery bypass grafting (OPCAB) is used more widely in recent years in China. However, there is an argument on benefits and risks of off-pump surgery. Many studies shown that OPCAB had more benefits in short-term outcomes than conventional coronary artery bypass grafting(CCABG). But evidences from other studies suggested that OPCAB resulted in less long-term graft patency as compared with on-pump surgery. This study examined the longterm graft patency of OPCAB and CCABG performed by one surgeon. Methods 50 patients who had received surgical revascularization by a surgeon for more than 5 years were reviewed, 25 patients received conventional coronary artery bypass grafting ( group 1 ) and 25 patients received OPCAB ( group 2). All patients had angiograms for compareing the graft patency between the two groups. Results Among 25 patients in group 1,21 were male and 4 were female. The mean age of patients at surgery was (55.4 ±8.9) years. 15 cases had unstable angina, 16 patients had old myocardial infarction and 6 cases had diabetes.The ejection fraction (EF) was 0.58 ±0.14. The mean number of bypasses per patient was 3.32 ±0.63. Mean duration of operation was (3.58 ± 0. 82) hours. Mean follow-up duration was ( 86.52 ± 12.48) months. 83 grafts were evaluated for patency ( open vs. closed) and were graded by Fitzgibbon as grade A ( excellent graft), B ( impaired graft, with a stenosis of ≥50%, or a diameter less than 50% of the grafted artery), or O ( completely occluded). The graft patency was 73.49%, 61grafts were graded as Fitzgibbon A, 6 grafts as Fitzgibbon B and 16 grafts as Fitzgibbon 0. 25 patients were in group 2, 21males and 4 females. The mean age of patients at procedure was (58.2 ± 9.09) years, 11 patients had unstable angina, 13 patients had old myocardial infarction and 6 cases had diabetes. The ejection fraction (EF) was 0.59 ± 0. 14. Conclusion No 2011.03.013 difference in long-term graft patency was identified between on-pump and off-pump coronary artery bypass grafting. Off-pump oronary artery bypass grafting preformed by an experienced surgeon may gain similar long-term graft patency to that of conventional bypass.     

冠状动脉旁路移植术术中检测血管桥通畅性的方法

冠状动脉旁路移植术（coronary artery bypass grafting，CABG）术中血管桥的质量与围手术期心血管事件、术后并发症的发生、病死率及手术的远期效果有密切的关系。因此，采用何种有效的方法在CABG术中对血管桥的质量进行准确的评估是临床上亟待解决的问题。本文就近年来的相关文献对此予以归纳与总结。[第一段]     

冠状动脉旁路移植术后心肌缺血的相关危险因素分析

目的分析冠状动脉旁路移植术后心肌缺血的相关危险因素。方法回顾性分析2013-07—2014-07月收治的163例冠状动脉旁路移植术(CABG)患者,根据其是否在术后出现心肌缺血(PMI)分为PMI组和非PMI组。对比2组患者一般情况、血液生化指标。采用多变量Logistic回归分析患者术后并发率的预测因素。结果 PMI组患者的年龄65岁、前壁MI、STEMI、高血压、高血脂、饮酒、糖尿病均显著高于非PMI组,差异具有统计学意义(P0.05)。PMI组的白细胞、血肌酐、CK-MB、TNI、hs-CRP、TG、TC、BNP、LDL-C均显著高于非PMI组,HDL-C显著低于非PMI组(P0.01)。采用多变量Logistic回归分析得出,年龄、血肌酐、hsCRP、前壁MI、HDL-C、LDL-C是患者CABG术后出现PMI并发症的预测因素(P0.05)。结论高龄、血肌酐和hs-CRP水平升高、前壁MI、BNP升高、LDL-C水平升高、HDL-C水平降低是冠状动脉旁路移植术后围术期出现心肌缺血的影响因素,临床需根据这些危险因素进行针对性的防治,以避免出现术后并发症,加重病情。     

冠状动脉旁路移植术后心房颤动的相关因素分析

目的 了解冠状动脉旁路移植术（CABG）后心房颤动（Af)的发生率以及相关因素，并探讨可能的防治措施。方法 回顾性地总连续322例单纯CABG病例，并将患者分为Af组和非Af组。收集术前、术中、术后资料进行统计分析。结果 CABG术后Af的发病率为23．3％（75例），最常见于术后第1－3天。年龄大于65岁、右冠状动脉近－中段狭窄大于50％、术后早期未服用β阻滞剂为独立危险因素。结论 Af是CABG术后最常见的并发症，年龄和右冠状动脉病可以影响Af的发生，应用β阻滞剂和补充镁可能是预防术后早期Af发生最经济、有效的方法。     

Risk Factors for Graft Occlusion after Coronary Artery Bypass Grafting

A cohort of 610 well-characterized patients undergoing coronary artery bypass grafting were followed through the first postoperative year. Graft patency was angiographically assessed in 578 (94.8%) of the patients on average 12.1 (SD 1.5) months postoperatively and was related to characteristics of grafts and patients. For internal mammary artery grafts the incidence of graft occlusion was higher in women than in men and was inversely related to body surface area. In multivariate analysis the influence of gender was no longer significant when adjusted for body surface area. With vein grafts the incidence of occlusion was inversely related to body surface area and was positively associated with ejection fraction. Occlusion of vein grafts was less common in patients treated with beta-blockers pre-and peroperatively.     

Rescue Coronary Artery Bypass Grafting (CABG) after Aortic Composite Graft Replacement

Abstract Background: Aortic root replacement (ARR) has been recognized as the standard therapy for diseases of the aortic root since its introduction into clinical practice. ARR currently provides excellent long‐term benefit with acceptable perioperative risk and excellent long‐term morbidity and mortality. During ARR, coronary button misalignment may produce myocardial ischemia, ventricular arrhythmias, and pump failure leading to death if unrecognized. Here we review our experience with coronary insufficiency after ARR. Methods: Between January 1995 and March 2006, 139 consecutive patients underwent ARR at Yale‐New Haven Hospital. A retrospective review of their medical records was conducted. The mean age of the patients was 54.5 years. Aortic root aneurysm was the indication for surgery in 123 patients, acute type A dissection in 14, and endocarditis in two. Results: All patients underwent a modified Bentall operation with a mechanical (87%) or biological (13%) valve prosthesis and coronary artery button reimplantation. The overall 30‐day mortality was 4.3% (six patients). Three patients (2.2%) underwent rescue coronary artery bypass grafting (CABG) to the left, right, or both coronary arterial systems for ischemia due to presumed coronary button misalignment. These patients presented with ventricular arrhythmias or hemodynamic compromise. All three showed excellent response to rescue CABG and remain alive and well in late follow‐up. Conclusion: Coronary insufficiency after reconstruction of the aortic root is an uncommon but acutely life‐threatening occurrence. This lethal condition may present with difficulty in weaning from cardiopulmonary bypass; echocardiographic signs of major wall motion abnormalities; and electrocardiographic evidence of ischemia, pump failure, and ventricular arrhythmias. Rescue CABG in this situation is life‐saving. Immediate rescue CABG should be performed if coronary ischemia is suspected after composite graft replacement of the aortic root.