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山东大学学报(医学版) ›› 2016, Vol. 54 ›› Issue (8): 34-38.doi: 10.6040/j.issn.1671-7554.0.2015.752

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冠状动脉旁路移植术后桡动脉桥血管通畅率的影响因素分析

叶聪   

  1. 上海交通大学附属瑞金医院外科基地, 上海 200025
  • 收稿日期:2015-08-10 出版日期:2016-08-10 发布日期:2016-08-10
  • 通讯作者: 叶聪. E-mail:yecong1989@yeah.net E-mail:yecong1989@yeah.net

Influencing factors for the graft patency of radial artery after coronary artery bypass grafting surgery

YE Cong   

  1. Surgical Base, Ruijin Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200025, China
  • Received:2015-08-10 Online:2016-08-10 Published:2016-08-10

摘要: 目的 分析冠状动脉旁路移植术(CABG)后桡动脉(RA)桥通畅率的影响因素。 方法 回顾性分析在CABG术中使用RA桥,并于术后1年复查冠状动脉计算机断层扫描血管造影术(CTA)患者65例。收集患者术前、术中及术后的相关资料,采用多因素logistic回归分析筛选RA桥通畅率的影响因素。 结果 RA桥靶血管近端狭窄程度≥80%(OR=0.212, 95%CI: 0.049~0.912, P=0.037)和靶血管在左前降支区域(OR=0.104, 95%CI: 0.012~0.921, P=0.042)是RA桥术后通畅率的独立保护因素,而术后未规范联用抗痉挛药物(OR=6.825, 95%CI: 1.857~25.083, P=0.004)是RA桥通畅率的独立危险因素。 结论 CABG术中RA桥靶血管的合理选择和术后联用抗痉挛药物是RA桥通畅率的独立影响因素。

关键词: 桡动脉, 通畅率, 影响因素, 冠状动脉旁路移植术

Abstract: Objective To analyze the influencing factors for the graft patency of radial artery(RA)after coronary artery bypass grafting(CABG). Methods Clinical data of 65 patients who adopted RA grafts in isolated CABG and underwent computed tomography angiography one year after operation were retrospectively analyzed, including preoperative, intraoperative and postoperative data. Multiple logistic regression analysis was performed to explore the influencing factors for RA graft patency. Results Native stenosis of target vessel ≥80%(OR=0.212, 95%CI: 0.049-0.912, P=0.037), and target vessel in the left anterior descending artery territory(OR=0.104, 95%CI: 0.012-0.921, P=0.042)were independent protective factors for RA graft patency, while non-adherence to the postoperative combination of anti-spastic medications(OR=6.825, 95%CI: 1.857-25.083, P=0.004)was an independent risk factor. Conclusion Proper choice of target vessels during the operation and combination of anti-spastic medications after operation are independent influencing factors for RA graft patency.

Key words: Predictive factor, Coronary artery bypass grafting, Radial artery, Patency rate

中图分类号: 

  • R654.2
[1] Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial[J]. Lancet, 2013, 381(9867): 629-638.
[2] Loop FD, Lytle BW, Cosgrove DM, et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events[J]. N Engl J Med, 1986, 314(1): 1-6.
[3] Tranbaugh RF, Dimitrova KR, Friedmann P, et al. Coronary artery bypass grafting using the radial artery: clinical outcomes, patency, and need for reintervention[J]. Circulation, 2012, 126(11 Suppl 1): 170-175.
[4] Locker C, Schaff HV, Dearani JA, et al. Multiple arterial grafts improve late survival of patients undergoing coronary artery bypass graft surgery: analysis of 8622 patients with multivessel disease[J]. Circulation, 2012, 126(9): 1023-1030.
[5] Deb S, Cohen EA, Singh SK, et al. Radial artery and saphenous vein patency more than 5 years after coronary artery bypass surgery: results from RAPS(Radial Artery Patency Study)[J]. J Am Coll Cardiol, 2012, 60(1): 28-35.
[6] Goldman S, Sethi GK, Holman W, et al. Radial artery grafts vs saphenous vein grafts in coronary artery bypass surgery: a randomized trial[J]. JAMA, 2011, 305(2): 167-174.
[7] Athanasiou T, Saso S, Rao C, et al. Radial artery versus saphenous vein conduits for coronary artery baypass surgery: forty years of competition-which conduit offers better patency? A systematic review and meta-analysis[J]. Eur J of Cardiothorac Surg, 2011, 40(1): 208-220.
[8] Sahiner L, Canpolat U, Yorgun H, et al. Diagnostic accuracy of dual-source 64-slice multidetector computed tomography in evaluation of coronary artery bypass grafts[J]. J Investig Med, 2012, 60(8): 1180-1185.
[9] Desai ND, Cohen EA, Naylor CD, et al. A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts[J]. N Engl J Med, 2004, 351(22): 2302-2309.
[10] Khot UN, Friedman DT, Pettersson G, et al. Radial artery bypass grafts have an increased occurrence of angiographically severe stenosis and occlusion compared with left internal mammary arteries and saphenous vein grafts[J]. Circulation, 2004, 109(17): 2086-2091.
[11] Acar C, Jebara VA, Portoghese M, et al. Revival of the radial artery for coronary artery bypass grafting[J]. Ann Thorac Surg, 1992, 54(4): 652-659.
[12] He GW, Fan L, Furnary A, et al. A new antispastic solution for arterial grafting: nicardipine and nitroglycerin cocktail in preparation of internal thoracic and radial arteries for coronary surgery[J]. J Thorac Cardiovasc Surg, 2008, 136(3): 673-680.
[13] Achouh P, Boutekadjirt R, Toledano D, et al. Long-term(5- to 20-year)patency of the radial artery for coronary bypass grafting[J]. J Thorac Cardiovasc Surg, 2010, 140(1): 73-79.
[14] Gaudino M, Glieca F, Luciani N, et al. Clinical and angiographic effects of chronic calcium channel blocker therapy continued beyond first postoperative year in patients with radial artery grafts: results of a prospective randomized investigation[J]. Circulation, 2001, 104(12 Suppl): 64-67.
[15] Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J]. Circulation, 2011, 124(23): 2610-2642.
[16] Yie K, Na CY, Oh SS, et al. Angiographic results of the radial artery graft patency according to the degree of native coronary stenosis[J]. Eur J Cardiothorac Surg, 2008, 33(3): 341-348.
[17] Collins P, Webb CM, Chong CF, et al. Radial artery versus saphenous vein patency randomized trail: five-year angiographic follow-up[J]. Circulation, 2008, 117(22): 2859-2864.
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