自体桡动脉在不停跳冠状动脉旁路移植术中的应用

The Radial Artery for Off-pump Coronary Artery Bypass Graft

目的探讨自体桡动脉(radial artery,RA)在不停跳冠状动脉旁路移植术(off-pump coronary artery bypass graft,OPCABG)中应用的效果及安全性。方法回顾性分析我院2009年10月～2012年10月375例应用自体桡动脉(radialartery,RA)进行OPCABG的临床资料,对老年组(年龄≥60岁,n=184)及非老年组(年龄<60岁,n=191)临床结果进行比较。结果 375例平均搭桥(3.0±0.7)支,共使用392支RA,其中右冠状动脉系统307支,前降支系统37支,回旋支系统48支。术后RA移植物相关心电图改变发生15例,无围手术期心肌梗死发生,无RA取材并发症。住院死亡率老年组为1.1%(2/184),非老年组为1.0%(2/191),2组比较无统计学差异(χ2=0.000,P=1.000);主动脉球囊反搏(intra-aorticballoon pump,IABP)使用率老年组为7.6%(14/184),非老年组为6.3%(12/191),2组比较无统计学差异(χ2=0.255,P=0.613);老年组住院时间(21.8±9.3)d,与非老年组(21.8±8.6)d无统计学差异(t=0.000,P=1.000);老年组移植血管数(3.1±0.7)支,与非老年组(3.1±0.7)支无统计学差异(t=0.000,P=1.000)。273例随访3～36个月,(16.8±10.0)月,死亡5例,均为非心脏源性;23例术后残留心绞痛症状,均无心电图及影像学证据显示与RA移植物有关。结论自体RA在OPCABG中使用安全有效,有很好的近期临床效果,老年患者和非老年患者临床效果并无显著性差异。

Objective To explore the safety and feasibility of using radial artery for off-pump coronary artery bypass graft. Methods We reviewed our experience with 375 patients undergoing radial artery （RA） myocardial revascularization （ off-pump coronary artery bypass graft, OPCABG） between October 2009 and October 2012. The patients were divided into the elder group （60 years old or more, n = 184） or the younger group （younger than 60 years old, n = 191 ）. The clinical outcomes were studied. Results There were a mean of 3.0 ＋0.7 anastomoses per patient. Totally 392 RA grafts were used, including 307 for right coronary artery system, 37 for left anterior descending system, and 48 for left circumflex system. 15 RA grafts spasm were found and all were transient. No postoperative myocardial infarction and major complication related to radial artery harvesting were observed. The clinical data were not statistically different between the elder group and the younger group in hospital mortality [ 1.1% （2/184） vs. 1.0% （2/191）, X2 =0. 000 ,P = 1. 000] ,intra-aortic balloon pump（IABP） [ 7.6% （ 14/184 ） vs. 6.3 （ 12/191 ）, X2 = 0. 255, P = O. 613 ], hospital stay [（21.8~9.3）dvs. （21.8~8.6）d, t=0. OO0,P=l.000], grafts （3.1 ~0.7 vs. 3.1 ＋0.7, t=0.000,P=l. O00）. A 3-month to 3-year follow-up study was carried out with a cohort of patients who underwent OPCABG. Of the 273 cases, 5 cases died of non-cardiogenic complications; 23 cases still suffered from angina pectoris, which was not associated with radial artery grafts as determined by electrocardiogram and imaging. Conclusion The use of RA for OPCABG is safe and effective for both senior and non-senior patients suffering from coronary heart diseases, with no significant difference found in clinical efficacy between the two groups.