冠状动脉旁路移植术后远期左乳内动脉桥血管血流储备影响因素分析

Analysis of long-term influencing factors of coronary flow reserve of left internal mammary artery grafts after coronary artery bypass grafting

目的:测定冠状动脉旁路移植(CABG)术后左侧乳内动脉(LIMA)桥血管血流储备(CFR),分析CABG术后远期LIMA桥血管CFR的影响因素。方法:纳入以LIMA为左前降支(LAD)桥血管的CABG术后患者107例,CABG术后时间(17.58±14.45)个月,采用经胸多普勒超声心动图测定LIMA桥血管CFR及吻合口近端LAD的CFR。结果:所有患者测得桥血管CFR,CFR桥血管为2.70±0.82,28例患者可见吻合口近端LAD逆向血流,CFRLAD为2.10±0.97。CFR桥血管<2.5患者44例(41.12%)。CFR桥血管<2.5组患者劳力性胸痛发生率明显高于CFR桥血管≥2.5组患者(29.55%∶7.94%,P=0.005)。合并高血压患者桥血管CFR明显低于无高血压患者[(2.52±0.74):(3.02±0.86),P=0.002],合并糖尿病患者桥血管CFR明显低于无糖尿病患者[(2.39±0.65):(2.85±0.86),P=0.003]。多因素分析显示高血压、糖尿病为桥血管CFR独立预测因素(P<0.05)。结论:高血压、糖尿病是CABG术后远期LIMA桥血管CFR独立预测因素,CFR桥血管<2.5患者劳力性胸痛发生率高。

Objective:To measure coronary flow reserve(CFR)of the left internal mammary artery(LIMA)bypass in patients after coronary artery bypass grafting(CABG).Analyses the factors influencing LIMA bypass CFR in the long term after CABG.Method:One hundred and seven patients after CABG using LIMA as the bypass of left anterior descending(LAD)were included,and the follow-up time after CABG was(17.58±14.45)months.CFR of LIMA bypass was measured by transthoracic doppler echocardiography.Result:The CFRbypassin all patients was 2.70±0.82.The reverse flow of LAD in the proximal anastomotic site was found in 28 patients,and the CFRLADwas 2.10±0.97.44(41.12%)patients had CFRbypass<2.5.The incidence of exertive chest pain in patients with CFRbypass<2.5 was significantly higher than that in patients with CFRbypass≥2.5(29.55%∶7.94%,P=0.005).CFRbypassin patients with hypertension was significantly lower than that in patients without hypertension[(2.52±0.74):(3.02±0.86),P=0.002],and CFRbypassin patients with diabetes mellitus were significantly lower than that in patients without diabetes mellitus[(2.39±0.65):(2.85±0.86),P=0.003].Multiple analysis showed that hypertension and diabetes mellitus were the independent predictors for CFRbypass(P<0.05).Conclusion:Hypertension and diabetes mellitus were independent predictors for CFR of LIMAbypass in the long term after CABG,and the incidence of exertive chest pain was high in patients with CFRbypass<2.5.