选择性冠状静脉动脉化搭桥术中不同移植物的应用疗效比较

Efficacy Comparison of Different Grafts in Selective Coronary Venous Bypass Grafting

目的:对比选择性冠状静脉动脉化(SCVBG)搭桥治疗弥漫性右冠状动脉狭窄病变中选择乳内动脉和大隐静脉作为桥血管的治疗效果。方法:选择2008年10月到2014年10月在我院行SCVBG搭桥的84例患者资料,其中选择大隐静脉作为桥血管进行冠状静脉动脉化搭桥患者46例(大隐静脉桥组),选择乳内动脉作为桥血管进行冠状静脉动脉化搭桥患者38例(乳内动脉桥组)。随访记录两组患者的生存情况、近期复查超声心动图、冠状动脉CTA及心绞痛复发率。结果:乳内动脉桥组患者总生存率(100%)明显高于大隐静脉桥组(82.6%)(P<0.05)。乳内动脉桥组患者桥血管和心中静脉通畅率(100%)明显大于大隐静脉桥组(54.35%)(P<0.05)。两组患者左心室射血分数(LVEF)较治疗前明显增加,左心室舒张期末内径(LVEDD)较治疗前明显减小(P<0.05)。治疗后,乳内动脉桥组患者心绞痛复发率明显小于大隐静脉桥组(P<0.05)。结论:SCVBG搭桥治疗弥漫性右冠状动脉狭窄病变中,选择乳内动脉桥效果优于大隐静脉桥,能明显提高桥血管和心中静脉通畅率,降低心绞痛复发率。

Objective： To compare the efficacy of internal mammary artery grafts and great saphenous vein grafts in selective coronary venous bypass grafting （SCVBG） for the patients with diffuse right coronary artery stenosis. Methods： The medical records of 84 patients, who underwent SCVBG in Wuxi People＇s Hospital from October 2008 to October 2014, were selected. Among them,46 patients were chosen great saphenous veins as grafts in SCVBG （as great saphenous vein group）, while 38 patients, internal mammary artery as graft （as internal mammary artery group）. The survival rates, relapse rates of angina, recent echocardiographic and coronary CT angiography （CTA） results in the two groups were followed up and recorded. Results： Overall survival rate （100%） in the internal mammary artery group was higher than that（82.6%） in the great saphenous vein group （P〈0.05）. The patency rate（100%） of vessel bridge and heart vein in the internal mammary artery group were higher than that in the great saphenous vein group（54.35%）（P〈0.05）. Compared with before treatment, the left ventricular ejection fraction （LVEF） increased, and the left ventricular end diastolic diameter（LVEDD） reduced in the two groups（P〈0.05）. The relapse rate of angina in the internal mammary artery group after treatment was lower than that of the great saphenous vein group （P〈0.05）. Conclusion： In SCVBG for the patients with diffuse right coronary artery stenosis, the internal mammary artery graft has better efficacy than great saphenous vein graft, which can significantly improve the patency rate of vessel bridge and heart vein and reduce the relapse rate of angina.