老年人冠状动脉旁路移植术中桡动脉与大隐静脉应用的对比研究

Comparative Application Study of Radial Artery and Great Saphenous Vein for Coronary Artery Bypass Grafting in Elder Patients

目的:比较在60岁以上老年患者冠状动脉(冠脉)旁路移植术(CABG)中同时应用桡动脉与大隐静脉时的切口并发症及远期通畅率,探讨在老年冠心病患者中应用桡动脉的可行性。方法:回顾性分析2004-01至2010-01在我院同时采用桡动脉、大隐静脉行CABG的60岁以上冠心病患者资料,比较桡动脉与大隐静脉取材术后并发症的发生率及桥血管远期通畅率。共332例60岁以上CABG患者纳入本研究,平均(66.0±4.9)岁。桡动脉取材前均行多普勒超声,术后采用钙拮抗剂为主的抗痉挛策略。结果:住院期间死亡6例,死亡率1.8%。桡动脉取材术后切口疼痛、活动受限及血肿发生率与大隐静脉取材无统计学差异(P>0.05),但术后切口麻木、肿胀及感染发生率显著低于大隐静脉取材(P均<0.05)。至2012-12止,共完成随访307例,随访率92.5%,其中177例患者术后(58.0±23.7)个月选择性冠脉造影或多排冠脉计算机断层扫描术(CT)复查显示桡动脉桥通畅率为84.2%(149/177),显著高于大隐静脉桥通畅率(71.2%,126/177),P<0.05,差异均有统计学意义。结论:经过多普勒超声筛选及应用适宜的抗痉挛策略,在老年冠心病患者中应用桡动脉桥,可获得优于大隐静脉桥的临床效果,有望在老年CABG患者术中发挥重要作用。

Objective： To investigate the harvest site complication and long term graft patency rate between autologous radial artery and great saphenous vein for coronary artery bypass grafting （CABG） in elder patients. Methods ： We retrospectively analyzed 332 patients at （66.0 ＋ 4.9） years of age who received CABG with autologous radial artery and great saphenous vein at the same time in our hospital from 2004 to 2010, and compared their early harvest site complication and long term graft patency rate between those 2 kinds of vessels. Before harvest, the radial artery was routinely examined by Doppler ultrasound, and calcium antagonist was used for anti-spasm after the procedure. Result： The in-hospital death were 6/332 （1.8%） of patients. There were no significant differences in harvest site pain, hematoma and the limitation of activity between 2 kinds of grafting vessels, P〉O05. While the incidences of numbness, swelling and infection in radial artery harvest site were obviously lower than those in great saphenous vein, P〈0.05 respectively. There were 307/332 （92.5%） of patients follow-up by December 2012 and 177 patients received coronary angiography or CTA examination for graft patency at （58.0 ± 23.7） months after the procedure. The graft patency rates of radial artery and great saphenous vein were 149/177 （84.2%）＇vs. 126/177 （71.2%）, P〈0.05. Conclusion： With pre-operative ultrasound evaluation and suitable anti-spasm treatment, radial artery could be a better alternative vessel for CABG than that of great saphenous vein in elder patients.