本文選題：冠狀動脈旁路移植術(shù)　切入點：橈動脈橋　出處：《上海交通大學(xué)》2015年博士論文　論文類型：學(xué)位論文

【摘要】：目的冠狀動脈旁路移植術(shù)(CABG)目前是針對冠狀動脈多支病變的主要治療手段,而全動脈化再血管化是未來CABG的發(fā)展趨勢,橈動脈(RA)是常用的動脈移植物之一。本文通過回顧性研究,評估CABG術(shù)后RA橋及其它種類橋血管的通暢率,并分析RA橋通暢率的影響因素。方法研究對象為2009年5月-2014年1月間至瑞金醫(yī)院行單純CABG術(shù),并于術(shù)后一年行冠狀動脈CTA復(fù)查的病例。共納入1173例患者,評估橋血管3791根(以遠(yuǎn)端吻合口計),其中左乳內(nèi)動脈(LIMA)橋850根,大隱靜脈(SVG)橋2823根,RA橋112根,右乳內(nèi)動脈(RIMA)橋6根。冠狀動脈CTA示橋血管閉塞或重度狹窄(狹窄≥70%)視為橋血管“病變”,否則視為“通暢”。1173例患者中有65例使用RA橋(RA組),根據(jù)RA橋是否存在病變,將這65例患者分為正常組(n=52)和異常組(n=13),將其112根RA橋(以遠(yuǎn)端吻合口計)分為通暢組(n=96)和病變組(n=16)。另根據(jù)橋血管組成的不同,將這65名患者分為4個亞組,“LIMA橋+RA橋”亞組(n=41),“LIMA橋+RA橋+SVG橋”亞組(n=21),“RA橋+SVG橋”亞組(n=1)和“RA橋”亞組(n=2)。收集相關(guān)資料,用單因素分析和logistic多因素分析篩選RA橋通暢率的影響因素。、結(jié)果術(shù)后一年冠狀動脈CTA結(jié)果示,RA橋的總通暢率為85.7%(96/112),完全閉塞率為7.1%(8/112),功能性閉塞率為5.4%(6/112),重度狹窄率為1.8%(2/112)。RA橋術(shù)后中遠(yuǎn)期(3-4年)再通率為50%(2/4)。同期LIMA橋的通暢率為95.6%,優(yōu)于RA橋(P0.01)。RA橋的通暢率與同期SVG橋(89.5%)相比,差異不顯著�！癓IMA橋+RA橋”亞組中,LIMA橋(97.6%)與RA橋(84.9%)的通暢率無顯著差異(P=0.073)�！癓IMA橋+RA橋+SVG橋”亞組中,LIMA橋(90.5%)、RA橋(85.3%)、SVG橋(89.7%)三者間通暢率無顯著差異。單因素分析示,患者術(shù)前左室射血分?jǐn)?shù)(P=0.025)、術(shù)后是否規(guī)范聯(lián)用抗痙攣藥物(P=0.013)、靶血管近端狹窄程度(P=0.008)、靶血管區(qū)域(P=0.020)是RA橋術(shù)后通暢率的潛在影響因素。Logistic多因素分析示,術(shù)后未規(guī)范聯(lián)用抗痙攣藥物(OR=6.825,95%CI:1.857-25.083,P=0.004)是RA橋術(shù)后通暢率的獨立危險因素,而靶血管近端狹窄程度≥80%(OR=0.212,95%CI:0.049-0.912,P=0.037)和靶血管位于LAD區(qū)域(OR=0.104,95%CI:0.012-0.921,P=0.042)是RA橋術(shù)后通暢率的獨立保護(hù)性因素。結(jié)論RA橋的近期通暢率滿意。術(shù)后未規(guī)范聯(lián)用抗痙攣藥物是RA橋術(shù)后通暢率的獨立危險因素,靶血管近端狹窄程度≥80%和靶血管位于LAD區(qū)域是RA橋術(shù)后通暢率的獨立保護(hù)性因素。RA橋的再通和遠(yuǎn)期通暢率有待進(jìn)一步觀察和研究。
[Abstract]:Objective Coronary artery bypass grafting (CABG) is the main treatment for coronary artery disease, and total arterialization and revascularization is the development trend of CABG in the future. Radial artery grafts (RAA) is one of the commonly used grafts. The patency rate of RA grafts and other grafts after CABG was evaluated by retrospective study. Methods CABG was performed from May 2009 to January 2014 in Ruijin Hospital, and coronary artery CTA was performed one year after operation. A total of 1173 patients were included in the study. Methods: a total of 3791 graft vessels (including 850 left internal mammary artery LIMA) and 2823 RA grafts were evaluated, including 112 RA grafts, among them, 3 791 grafts (including left internal mammary artery (LIMA)) and 2 823 large saphenous vein (SVG) grafts. The coronary artery CTA showed that the grafts were occluded or severe stenosis (stenosis 鈮，

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