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冠状动脉旁路移植术后心绞痛复发患者冠状动脉造影特点分析

刘颖1,刘寅2,王林2,Mukunda Sharma1   

  1. 1. 天津胸科医院
    2. 天津市胸科医院
  • 收稿日期:2011-09-26 修回日期:2011-12-05 出版日期:2012-03-15 发布日期:2012-03-15
  • 通讯作者: 刘颖

Analysis of Angiographic Characteristics and Treatment of 430 subjects of Reccurrenct Angina after Coronary Artery Bypass Grafting

  • Received:2011-09-26 Revised:2011-12-05 Published:2012-03-15 Online:2012-03-15

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摘要： 目的 总结冠状动脉旁路移植术（CABG）后心绞痛复发患者桥血管造影特点，分析桥血管病变危险因素，探讨治疗策略。方法 分析2005年8月至2011年5月 我院因CABG术后心绞痛复发430例患者冠状动脉造影（CAG）结果，男性326例，女性106例，平均年龄（63.6±8.93）岁，复查CAG的平均间隔时间（46.9±31.8）个月。结果 共计1133支桥血管。IMA病变率21.5%(56/261)，SVG病变率32.4% (279/861)，桡动脉病变率81.8%（8/11）。LIMA的通畅率高于SVG（P＜0.05），吻合于不同靶血管的桥血管病变率之间存在差异。非体外循环下CABG者再次介入治疗率高于体外循环者（P＜0.05），LIMA组及SVG组中靶血管直径≥2.0mm的桥血管病变率低于靶血管直2.0mm者（P＜0.05）。经logistic 回归分析，糖尿病，高脂蛋白（a）血症，高极低密度脂蛋白血症，低高密度脂蛋白血症SVG病变的危险因素。桥血管病变者多选择药物治疗，桥血管病行介入治疗者中选择自体动脉介入者与选择桥血管介入者两者间再狭窄率差异无统计学意义。结论 影响桥血管病变因素众多，合理安排手术方案，合理用药可减少SVG病变。

关键词: 冠状动脉搭旁路移植术, 冠脉造影, 危险因素

Abstract: Objectives To investigate the angiographic characteristics and risk factors that affect graft patency underwent coronary artery bypass graft（CABG）.Methods Investigate from August 2005to May 2006,430 ptatients after CABG underwent coronary arteriograph (CAG) in our hospital due to recurrence of angina.There are 324 males and 106 females. Result The average age is (63.6±8.93) years. The average duration from CABG to CAG was (46.9±31.8) months.There are 1133 grafts , including 260 LIMA grafts,861 SVG 19 RA grafts and 1RIMA graft. Graft failure was found in 21.5%(56/261) of the IMA,32.4% (279/861)of the SVG,81.8%（8/11）of RA grafts. The patency rate of LIMA was higher the SVG(P<0.05) .There are different in patency rate of graft that to different target vessel. The rate of re-percutaneous intervention of off-pump was higher on-pump(P＜0.05).In LIMA group and SVG group, the patency rate of grafts of which the diameter of the target vessel is more than and equal to2.0mm higher than that of target vesel 2.0mm(P＜0.05). Multifactorial logistic regression analysis showed the LP(a),VLDL,diabetes were risk factors of the failure of SVG, HDL was protect factor. Most patients of SVG failure accepted drug treatment. There are no significant different between percutaneous intervention of SVG and self-vession(P>0.05). Conclusion Many factors affect the patency of grafts, select reasonable strategy of surgery and drug treatment was contribute to reduce the failure rate of grafts.

Key words: coronary artery bypass graft, coronary angiography, risk factors