冠状动脉旁路移植术后患者焦虑抑郁状态危险因素研究

目的:探讨三级医院冠状动脉旁路移植术(CABG)患者,术后焦虑抑郁状态及其相关危险因素。方法:应用前瞻性研究方法,采用综合性医院焦虑抑郁量表,对本院180例CABG患者围术期行心理测评,评价术后焦虑抑郁状态的发生率,根据术后是否存在焦虑状态或(和)抑郁状态将患者分为焦虑抑郁状态组(n=103例)和对照组(n=77),对可能影响因素进行多因素Logistic回归分析。结果:1CABG患者术后焦虑、抑郁状态的发生率分别为42.2%、39%,二者均有的占23.9%;2单因素分析:文化程度低、无固定工作、负性家庭生活事件、患者为家中主要经济来源、术前合并焦虑抑郁、术前脑卒中史、初发心绞痛或心肌梗死、术后刀口疼痛评分>6分及ICU停留时间长为术后出现焦虑抑郁的危险因素(P<0.05);3Logistic回归分析:文化程度(P=0.018)、负性家庭生活事件(P=0.046)、术前合并焦虑抑郁(P=0.023)、初发心绞痛或心肌梗死(P=0.038)是术后出现焦虑抑郁的独立危险因素。结论:在基层三级医院,CABG患者术后焦虑抑郁状态发病率比较高,应该重视围手术期焦虑抑郁状态的筛查,采取有针对性的干预,从而改善预后,提高手术质量。     

冠状动脉搭桥围术期急性心肌梗死紧急再搭桥

目的：回顾性分析冠状动脉搭桥围术期急性心肌梗死急诊再搭桥的临床经验。方法：在510例冠状动脉搭桥患中，5例患在术后4h内因急性心肌梗死需急诊再搭桥，发生率0．98％。5例患中，男女比例为4：1，年龄56－77岁（平均63．6岁），均为冠状动脉三支血管病变（3例伴左主干病变），手术中搭桥3－5支（人均搭桥3．6支），左乳内动脉桥5根，其余为大隐静脉桥。2例在关胸后20min，3例在回重症监护病房后2－4h出现急性心肌缺血表现（明显心电图ST－T变化），伴室颤2例，5例血液动力学均不稳定，药物处理难以稳定血液动力学。全部患均立即送手术室（2例仍在手术室），急诊再次开胸。探查发现，2例患静脉桥（分别搭桥到回旋支第二钝缘支和右冠状动脉后降支）内急性血栓形成；另3例所有静脉桥良好，但左室前壁收缩运动明显减弱，结合心电图变化，诊断为左乳内动脉灌注不良。重新建立体外循环，清除桥内血栓重新搭桥2例（1例在非体外循环心脏跳动下进行）；另取一段静脉搭桥到左乳内动脉－左前降支吻合口远端的左前降支3例。结果：5例患顺利度过手术，均置入主动脉内球囊反搏，支持22－25h（平均42h）。手术后呼吸机支持4h－18d（平均7．3d）合并消化道出血4例，肾功能不全2例，肺部感染2例，切口感染1例。手术后住院时间12－35d，平均21d。全组均痊愈出院。结论：冠状动脉搭桥围术期急性心肌梗死应重在预防。如怀疑桥有问题，急诊再搭桥是良好选择，但手术后并发症发生率明显增加。     

冠状动脉旁路手术后康复

目的 :探讨冠状动脉搭桥术后早期康复运动的疗效。方法 :对 90例冠状动脉旁路手术患者于术后早期进行康复治疗。于胸部物理治疗的同时协助病人肢体各大关节、肌群先被动、后主动活动。待拔除引流管 2小时后 ,督促指导患者先平地行走后下台阶 ,逐渐至上、下 5层楼梯 (5METs) ,每日 2～3次。结果 :所有病人术后第 3日可下床活动。结论 :冠脉旁路手术的术前、后康复对病人早日回归社会有一定意义     

冠心病合并糖尿病患者冠状动脉旁路移植术长期预后及危险因素的探讨

目的 探讨糖尿病及其合并症对冠状动脉旁路移植术长期预后的影响。方法 将226例连续行冠状动脉主路移植术的冠心病患者分为糖尿病组（116例）和非糖尿病组（110例），应用多变量分析方法分析两组患者术前及术后的临床特征，并随访术后总死亡率及心脏性死亡的发生率，探讨糖尿病组心脏性死亡的预测因素。结果 两组术前及术后的临床特征、既往心肌梗死病史及冠状动脉病变支数等差异无显著性。结果 两组术前及术后的临床特征、既往心肌梗死病史及冠状动脉病变支数等差异无显著性。平均随访3.5年总死亡率两组差异无显著性，但心脏性死亡的发生率糖尿病组明显高于非糖尿病组（15％与3％，P＜0.01）。糖尿病和术后低左室射血分数与心脏性死亡的发生率密切相关（95％可信区间1.29-15.20)。糖尿病组的心脏性主要是猝死、心力衰竭和心肌梗死。术后低左室射血分数、女性及糖尿病肾病是主要预测因素。结论 冠心病合并糖尿病患者冠状动脉旁路移植术长期预后不良，特别在低左室射血分数、女性及糖尿病肾病患者心脏性死亡的发生率高，预后差。应加强对糖尿病患者冠状动脉旁路移植术后心、肾功能障碍的治疗。     

药物洗脱支架与冠状动脉旁路移植术治疗冠状动脉多支病变的比较

目的比较药物洗脱支架与冠状动脉旁路移植术治疗冠状动脉复杂多支病变的疗效。方法连续入选行血运重建治疗的冠心病多支病变患者200名,随机分为经皮冠状动脉介入(PCI)组和冠状动脉旁路移植术(CABG)组,每组100例。PCI组和CABG组中分别有合并糖尿病者(糖尿病亚组)27例和25例。观察术后1年内主要心脑血管不良事件(死亡、脑卒中、非致死性心肌梗死、靶血管再次血运重建)、再狭窄、心绞痛复发发生率,血浆肌酸激酶水平和PCI组支架内血栓形成发生率。结果两组患者的基线特征差异无统计学意义。PCI组与CABG组1个月、6个月和1年的主要心脑血管不良事件发生率分别为4.0%、7.0%、12.0%比6.0%、9.0%、15.2%(P>0.05);心绞痛复发率分别为2.0%、4.0%、6.0%比1.0%、3.0%、5.1%(P>0.05)。术后1年再狭窄率分别为11.3%比13.2%(P>0.05)。PCI组术后亚急性血栓形成率1.0%。PCI组和CABG组术后肌酸激酶MB型同工酶升高的患者比例分别为26%比82%(P<0.05)。PCI组糖尿病亚组与CABG组糖尿病亚组1个月、6个月和1年的严重心脑血管不良事件发生率分别为7.4%、11.1%、18.5%比8.0%、16.0%、24.0%(P>0.05)。结论药物洗脱支架时代PCI与CABG治疗冠状动脉多支病变的近、远期疗效相近,对于合并糖尿病的患者同样有效。     

70岁及以上老年患者非体外循环冠状动脉旁路移植术

目的　探讨非体外循环冠状动脉旁路移植术 (OPCAB)在 70岁及以上 (≥ 70岁 )老年冠心病患者施行的可行性和优越性。　方法　回顾性分析≥ 70岁患者 6 3例及 70岁以下 (<70岁 )患者197例施行OPCAB的临床资料。≥ 70岁组术前有脑血管病史和慢性阻塞性肺病史的比例大于 <70岁组 (P <0 0 5 ) ,其余相关因素差异无显著性。　结果　≥ 70岁组和 <70岁组平均远端吻合口数目分别为 (3 5± 0 9)个和 (3 4± 0 8)个 ,差异无显著性 (P >0 0 5 )。≥ 70岁组采用动脉桥的比例明显少于 70以下组 (分别占 12 7%及 5 2 3% ,P <0 0 1) ,监护时间大于 72h和机械通气大于 12h的比例 ,≥70岁组明显增多 (P <0 0 5 )。≥ 70岁组输血比例明显大于 <70岁组 (P <0 0 5 )。 2组死亡率分别为1 6 %和 1 0 % ,差异无显著性。心律失常的发生 ,≥ 70岁组明显多于 <70岁组 (P <0 0 5 ) ,其余并发症差异无显著性。　结论　OPCAB手术对于≥ 70岁老年冠心病患者同样安全可行 ,临床效果好     

冠状动脉旁路移植术后中期患者生命质量研究

目的 运用3个国外的生命质量(QOL)问卷对我院接受冠状动脉旁路移植术的患者进行QOL的研究,检验所使用问卷的信度和效度,并分析影响QOL的因素.方法 选择2001年1月至2002年1月于我院接受冠状动脉旁路移植术的患者,以书信的形式对287例患者发送QOL问卷,对问卷进行信度和效度的分析,并对影响QOL的因素进行分析.结果 共有273例患者寄回了问卷,3个QOL问卷的信度分析结果内部一致性系数分别为0.81、0.75、0.78.3个QOL问卷的结构效度分析结果显示存在不同程度的统计学相关性.对影响QOL的相关因素分析,3个问卷均提示术前加拿大心血管学会(CCS)心绞痛分级较严重患者的QOL低于术前CCS心绞痛分级较轻微患者的QOL.其中西雅图心绞痛问卷的"活动能力"、"疾病主观感受"亚组以及诺丁汉健康问卷的"社会孤独感"、"活动能力"亚组差异明显.结论 术前CCS心绞痛分级是影响冠状动脉旁路移植术后患者QOL的因素.     

冠状动脉旁路移植术治疗冠心病的体会

目的 探讨冠状动脉旁路移植术（CABG）对冠心病的治疗效果.方法 2005年7月至2010年 8月共行冠状动脉旁路移植术 82例,年龄38～78（61.8±12.7）岁,病程3个月至12年;有心肌梗死病史13例（15.6%）,合并高血压56例（68.3%）、糖尿病30例（36.5%）.术前心功能（NYHA）Ⅰ～Ⅲ级,Ⅰ级21例、Ⅱ级48例、Ⅲ级13例.手术在全麻体外循环下进行,取大隐静脉（SVG）与左乳内动脉（LIMA）,左乳内动脉与前降支（LAD）搭桥,其余用大隐静脉搭桥,平均每例搭桥（2.60±0.85）根,二尖瓣成形4例.结果 全组死亡1例,死于急性胰腺炎.术后低心排6例、房颤 10例,并发肺不张2例,4例术后引流多,二次开胸止血,1例术后第3天发现上纵隔增宽,二次开胸清除血块.结论 冠状动脉旁路移植术疗效显著,确切恢复和重建心肌血运,手术安全,结果令人满意.     

Mortality and morbidity after coronary artery bypass surgery related to pre-operative left ventricular ejection fraction: a follow-up study

OBJECTIVE: To study the pre-operative level of left ventricular ejectionfraction that may be indicative of an increased risk of earlyand late mortality and of recurrent angina pectoris and latenon-fatal myocardial infarction. MATERIAL AND METHODS: A total of 934 patients with known left ventricular ejectionfraction, 80 women and 854 men, were submitted to coronary arterybypass grafting at the Cardiovascular Unit of Rikshospitalet,Oslo, between August 1982 and December 1986. The closing datewas the 1st of January 1993, with a mean follow-up of time of7·4 years. The patients were divided in to four subgroupsaccording to their level of left ventricular ejection fraction:40%, 41–60%, 61–80% and >80%. The left ventricularejection fraction varied from 13–98%. A chi-square testof linear trend was used to calculate the relative risk betweenthe different subgroups. Cumulative survival was determinedusing survival curves. RESULTS: Early mortality. Twenty-five patients (2·7%) died within30 days of operation. Patients with left ventricular ejectionfraction 40% had a relative risk of 10·2 (1·9–17·2),for left ventricular ejection fraction 41–60% the relativerisk was 0·9 (0·1–8·9) and for leftventricular ejection fraction 61-80% the relative risk was 2·8(0·6–17·2). Left ventricular ejection fraction>80% was defined as relative risk=1. Late mortality. Altogether,174 patients died in the late phase (18·6%). For patientswith left ventricular ejection fraction 40% the relative riskwas 3·6 (2·8–10·9), for left ventricularejection fraction 41–60% the relative risk was 1·8(1·1–3·6),and for left ventricular ejectionfraction 61–80% the relative risk was 1·5 (0·9–2·8).Recurrent angina pectoris. A total of 138 patients developedrecurrent angina pectoris during the follow-up period, givingan incidence of 14·8%. Here, for left ventricular ejectionfraction 40% the relative risk was 0·5(0·2–13), for left ventricular ejection fraction 41–60% therelative risk was 1·0 (0·5–1·8) andfor left ventricular ejection fraction 61–80% the relativerisk was 1·2 (0·7–2·0). Late non-fatalmyocradial infarction. Altogether, 90 patients (9·6%)experienced non-fatal myocardial infarction in the late phase.For left ventricular ejection fraction 40% the relative riskwas 0·6(1·2–1·8), for left ventricularejection fraction 41–60% the relative risk was 1·0(0·5–2·0) and for left ventricular ejectionfraction 61–80% the relative risk was 0·7 (0·41–1·3).Cumulative survival. When pooled together, the cumulative survivalfor patients with left ventricular ejection fraction >40%was 95·9, 91·9 and 79% after 1, 5 and 10 years,respectively. For the patients with left ventricular ejectionfraction 40% cumulative survival was 87·5, 73·1and 55·2%, respectively. CONCLUSION: When the left ventricular ejection fraction was 40% or lower,there was a substantial increase in the risk of early mortalityin patients submitted to coronary artery bypass grafting. Asfor the risk of late mortality, there was a practically linearincrease in risk with falling values of left ventricular ejectionfraction. We found no difference in risk of developing recurrentangina pectoris or of late non-fatal myocardial infarction relatedto values of left ventricular ejection fraction.     

心脏瓣膜手术同期冠状动脉旁路移植术的临床探讨

目的 探讨心脏瓣膜手术同期冠状动脉旁路移植术的治疗效果.方法 回顾性分析2010年1月至2013年8月新疆医科大学第一附属医院心脏外科心脏瓣膜手术同期行冠状动脉旁路移植术45例患者的临床病例资料,对其进行整理统计分析,评价治疗效果.结果 患者术后左心室舒张末径较前明显减小,差异均有统计学意义（P＜0.01）;左心室射血分数较术前明显升高,差异均有统计学意义（P＜0.05）.术后早期（住院期间）死亡3例,其中2例发生低心排综合征、1例室颤均抢救无效死亡.通过电话及门诊复查,随访3～24个月,2例失访,失访率4.44％,无一例死亡.结论 心脏瓣膜手术同期行冠状动脉旁路移植术的治疗效果满意.充分的术前准备、合理的手术方案、有效的心肌保护措施、熟练的手术技术及术后的重症监护治疗是手术成功的关键.     

冠心病患者116例外科治疗体会

回顾应用冠状动脉旁路移植术（ｃｏｒｏｎａｒｙａｒｔｅｒｙｂｙｐａｓｓｇｒａｆｔｉｎｇ,ＣＡＢＧ）治疗冠心病的早期疗效和经验。方法１１６例病患中,９７％为多支冠状动脉病变。男性１０２例,女性１４例,年龄３５－８０岁,平均年龄６７．４岁。６３例左室射血分数≤４５％,１９例〈３０％。     

非体外循环冠状动脉旁路移植术后低氧血症相关因素分析

目的:分析非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass,OPCABG)后,低氧血症发生的相关因素并探讨预防及处理措施。方法:143例OPCABG患者,术后发生低氧血症40例,对低氧血症患者的年龄、体质量、术前心功能状态、不良习惯、手术时间、术中输液量、尿量、出血量、术中及术后输血量与非低氧血症患者之间,进行相关危险因素分析。结果:低氧血症患者与非低氧血症患者之间,在体质量、术前是否吸烟、手术时间、术中输液量及术后输血量之间,存在明显差异,所有低氧血症患者,在应用利尿、抗感染、呼吸末正压通气、延长机械通气时间治疗后好转,未出现死亡病例。结论:OPCABG术后,低氧血症易发生在体质量大、术前抽烟、手术时间长及术中输液量多的患者,应用抗感染、利尿、加用呼吸末正压等治疗后可纠正低氧血症。     

Radial artery as graft for coronary artery bypass surgery: Advantages and disadvantages for its usage focused on structural and biological characteristics

Radial artery (RA) is the most popular arterial graft after the left internal thoracic artery in both low- and high-risk patients undergoing coronary artery bypass grafting. Various arterial grafts such as the right internal thoracic artery, the right gastroepiploic artery, and the inferior epigastric artery have also gained ground over the past 30 years because of the intimal hyperplasia and atherosclerosis of the saphenous vein leading to late graft occlusion. In this review article we would like to present the utility of the RA as a graft, focused mainly on its structural and biological characteristics.     

冠状动脉旁路移植术后再次急性冠状动脉综合征患者的冠状动脉造影分析

目的分析接受冠状动脉旁路移植术(CABG)后的患者再次发作急性冠状动脉综合征(ACS)的时间与相关血管的关系.方法从本院1997～2001年间因CABG术后再次发作ACS而入院的168例患者中,选出行再次冠状动脉造影的患者43例,男38例,女5例,平均年龄(57.9±10.2)岁,再次发作ACS时间在术后次日至11年间.分析术后再次发作ACS的时间与罪犯血管之间的关系.结果 (1)由原自身冠状动脉血管病变加重导致的ACS共19例,占44.2%,由移植血管病变导致的共24例,占55.8%,其中12例移植血管病变发生在术后半年内,占移植血管病例的50%,且大部为吻合口病变.(2)从发作时间上划分,在术后次日至半年内发作ACS的为14例,占所有分析病例的32.6%.其中12例为移植血管病变所致,占整组病例的27.9%.随时间的延长,引起ACS的相关血管既有移植血管,也有原自身冠状动脉血管远端病变加重的血管,但术后3年内发作的ACS大多数由移植血管病变引起,检出率为75%,特异度为63%(P<0.01),3年后发生的ACS主要为未移植血管的原自身冠状动脉或移植血管远端的原自身冠状动脉血管病变加重所致.(3)所分析的43例患者共置入静脉血管桥99支,病变37支,总病变率37.4%,动脉桥31支,病变9支,总病变率29.0%.两者间差异有显著性(P<0.01).(4)桥病变的发生与患者综合危险因素间无明确相关性.结论 CABG术后3年内发作的ACS,其相关移植血管病变检出率为75%,特异度为63%,尤其半年内发生ACS的患者,移植血管病变检出特异度达89%,而且大部分为吻合口病变.移植血管病变的发生率与综合危险因素之间无明确相关性,但静脉移植血管的闭塞率要高于动脉移植血管.     

冠心病冠状动脉搭桥术后心电图的动态变化

目的　探讨冠心病冠状动脉搭桥术 (CABG)后心电图的动态变化。方法　回顾性比较 2 9例冠心病 CABG成功者术前与术后 1周、2～ 3周、2月及 3月等不同阶段 12导联心电图的变化。结果　与术前 (5 .6± 2 .6天 )比较 ,异常 Q波和 T波低平、双向的发生在术后第 1周显著增多 (16 .7%与 11.5 % ,P<0 .0 5 ,8.0 %与 2 .6 % ,P<0 .0 1) ,此后 ,异常 Q波的发生显著减少 (P<0 .0 5 ) ,T波低平或双向的发生则持续到第 2～ 3周后恢复到术前水平。 ST段压低 >1.0 m m和 T波倒置在术后第 2～ 3周、第 2月显著增多(5 .5 %、6 .3%与 2 .3% ,P<0 .0 5 ;31.3%、2 7.0 %与 17.8% ,P<0 .0 1) ,此后 ST段压低者减少到术前水平 ,T波倒置非常显著地减少 (9.2 %与 17.8% ,P<0 .0 1)。结论　冠心病病人 CABG术后出现早期一过性异常 Q波、T波低平或双向、ST段压低变化 ,此后上述改变逐渐减少恢复到术前水平。     

Prior coronary artery bypass graft surgery patients undergoing diagnostic coronary angiography have multiple uncontrolled coronary artery disease risk factors and high risk for cardiovascular events

Limited contemporary data exist on the cardiovascular risk of patients with prior coronary artery bypass grafting surgery (CABG) requiring diagnostic coronary angiography. We examined the prevalence and control of coronary artery disease risk factors and the outcomes of 367 prior CABG patients who underwent diagnostic coronary angiography between October 1, 2004 and May 31, 2007 at the Dallas Veterans Affairs Medical Center. Mean age was 65 ± 9 years, 97% were men, and the mean time from CABG to diagnostic angiography was 8.2 ± 6.1 years. Hypertension, low-density lipoprotein cholesterol, diabetes mellitus, smoking, and obesity were suboptimally controlled in 70%, 59%, 47%, 33%, and 50%, respectively. Intake of statins and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was 88% and 81%, respectively. After a mean follow-up of 1.4 ± 0.8 years, the incidence of death and major cardiovascular events was 10% and 32%, respectively. In spite of significant improvement compared to previous studies and good compliance with indicated medications, contemporary prior CABG patients undergoing coronary angiography still have multiple and poorly controlled coronary artery disease risk factors and high risk for cardiovascular events. Novel pharmacologic and behavioral treatment strategies are needed.     

冠心病合并糖尿病患者冠状动脉旁路移植术围手术期的处理

目的:研究伴冠心病合并糖尿病患者冠状动脉旁路移植术(CABG)围手术期的处理。方法:以2000年1月至2006年5月的189例冠心病行CABG患者为研究对象,按是否同时合并有糖尿病分为糖尿病组(56例)和无糖尿病组(133例),对比两组临床特点,搭桥支数,术后处理及术后并发症。结果:冠心病合并糖尿病患者冠脉病变广泛而严重(P<0.01),搭桥4支的比例明显高于非糖尿病组(56.3%∶19.63%,P<0.01)),术后并发症的发生率明显高于非糖尿病例组(P<0.01)。结论:冠心病合并糖尿病患者较无糖尿病患者冠脉病变更加严重,合并症更多,需认真、积极对待。     

Preoperative frailty and adverse outcomes following coronary artery bypass grafting surgery in US veterans

Background

Contemporary guidelines emphasize the value of incorporating frailty into clinical decision-making regarding revascularization strategies for coronary artery disease. Yet, there are limited data describing the association between frailty and longer-term mortality among coronary artery bypass grafting (CABG) patients.

Methods

We conducted a retrospective cohort study (2016–2020, 40 VA medical centers) of US veterans nationwide that underwent coronary artery bypass grafting (CABG). Frailty was quantified by the Veterans Administration Frailty Index (VA-FI), which applies the cumulative deficit method to render a proportion of 30 pertinent diagnosis codes. Patients were classified as non-frail (VA-FI ≤ 0.1), pre-frail (0.1 < VA-FI ≤ 0.2), or frail (VA-FI > 0.2). We used Cox proportional hazards models to ascertain the association of frailty with all-cause mortality. Our primary study outcome was 5-year all-cause mortality; the co-primary outcome was days alive and out of the hospital within the first postoperative year.

Results

There were 13,554 CABG patients (median 69 years, 79% White, 1.5% women). The mean pre-operative VA-FI was 0.21 (SD: 0.11); 31% were pre-frail (VA-FI: 0.17) and 47% were frail (VA-FI: 0.31). Frail patients were older and had higher co-morbidity burdens than pre-frail and non-frail patients. Compared with non-frail patients (13.0% [11.4, 14.7]), there was a significant association between frail and pre-frail patients and increased cumulative 5-year all-cause mortality (frail: 24.8% [23.3, 26.1]; HR: 1.75 [95% CI 1.54, 2.00]; pre-frail 16.8% [95% CI 15.3, 18.4]; HR 1.2 [1.08,1.34]). Compared with non-frail patients (mean 362[SD 12]), pre-frail (mean 361 [SD 14]; p < 0.01) and frail patients (mean 358[SD 18]; p < 0.01) spent fewer days alive and out of the hospital in the first postoperative year.

Conclusions

Pre-frailty and frailty were prevalent among US veterans undergoing CABG and associated with worse mid-term outcomes. Given the high prevalence of frailty with attendant adverse outcomes, there may be an opportunity to improve outcomes by identifying and mitigating frailty before surgery.     

冠状动脉搭桥术移植材料的选择

目的总结选择冠状动脉搭桥术移植材料的经验和体会。方法自2001年4月至2004年4月,我们选用乳内动脉、桡动脉和大隐静脉共90例冠心病患者行冠状动脉搭桥术。本组患者男性74例,女性16例,年龄48～74岁。心功能Ⅱ～Ⅳ级,单支血管病变6例,双支血管病变20例,三支血管病变64例。合并高血压30例,陈旧性心梗18例,慢性肺阻塞性通气障碍14例,糖尿病18例,室壁瘤3例,急性心梗2例。选用乳内动脉搭桥88支,桡动脉搭桥84支,大隐静脉搭桥109支。结果无死亡病例,全部痊愈出院。术后发生切口感染4例,胸骨裂开3例,胸腔积液8例,肺炎肺不张12例,心律失常15例。随访6～36个月,心电图检查无新的缺血和梗死表现,生活质量均有明显提高。结论正确的选择移植材料是提高血管桥通畅率、保证手术效果的关键措施。移植材料的选择应根据患者的全身情况和术者的技术水平决定。