CTA联合冠状动脉造影融合技术在冠状动脉搭桥术中及术后桥血管观察中的应用

Application of coronary CT angiography combined with coronary artery angiography fusion technology in the observation of grafts during and after coronary artery bypass grafting surgery

目的研究冠状动脉CT血管造影(CTA)联合冠状动脉造影(CAG)融合技术在冠状动脉搭桥术中及术后桥血管观察中的应用价值。方法回顾性选取2021年1月至2023年11月河南科技大学附属许昌市中心医院收治的60例行冠状动脉搭桥术患者,术中及手术结束单纯应用CAG观察桥血管31例患者为CAG组,应用CTA联合CAG融合技术观察桥血管29例患者为融合组,比较两组患者术中相关指标(寻找桥血管时间、总手术时间、对比剂量、总辐射时间、放射总剂量),术前、术后心功能[氨基末端脑利钠肽前体(NT-proBNP)]、肝功能[谷丙转氨酶(ALT)、谷草转氨酶(AST)]、肾功能[胱抑素C(CysC)、尿素氮(BUN)、血肌酐],并比较两种影像技术对术后12个月桥血管通畅率、狭窄病变率、闭塞病变率识别情况及图像质量的差异。结果融合组患者寻找桥血管时间、总手术时间、总辐射时间明显短于CAG组,对比剂量、放射总剂量明显低于CAG组,差异均有统计学意义(P<0.05);融合组患者术后血肌酐、CysC、BUN明显低于CAG组,差异均有统计学意义(P<0.05);两组患者均于术后12个月复查,融合技术观察桥血管的通畅率、狭窄病变率、闭塞病变率分别为94.83%、2.29%、2.87%,与CAG观察到的96.55%、0.57%、2.87%比较,差异均无统计学意义(P>0.05);融合技术图像质量优的占比为94.83%,高于CAG的84.48%,图像质量良、中的占比分别为5.17%、0,明显低于CAG的10.92%、4.59%,差异均有统计学意义(P<0.05)。结论CTA联合CAG融合技术可有效提高图像质量,改善术后心、肝、肾功能,降低术后桥血管闭塞率,为临床评估术后桥血管通畅情况提供参考依据,以针对性制定干预方案。

Objective To investigate the application value of coronary CT angiography(CTA)combined with coronary angiography(CAG)fusion technology in the observation of grafts during and after coronary artery bypass graft-ing surgery.Methods Sixty patients who underwent coronary artery bypass grafting surgery at the Xuchang Central Hospital Affiliated to Henan University of Science and Technology from January 2021 to November 2023 were retro-spectively selected,of which 31 who underwent CAG alone to observe the grafts during the operation were included in the CAG group,and 29 who underwent CTA combined with CAG fusion technology were included in the fusion group.The intraoperative relevant indicators(time of searching for grafts,total surgical time,contrast agent dose,total radiation time,total radiation dose),as well as preoperative and postoperative cardiac function[N-terminal pro-brain natriuretic peptide(NT-proBNP)],liver function[alanine aminotransferase(ALT)and aspartate aminotransferase(AST)],and renal function[Cystatin C(CysC),blood urea nitrogen(BUN),creatinine]were compared between the two groups of patients.The patency rate,stenosis rate,and occlusion rate of the grafts at 12 months after surgery were compared between the two imaging techniques,as well as image quality.Results The patients in the fusion group had significantly shorter time of searching for grafts,total operation time,and total radiation time than the CAG group,and the contrast agent dose and total radiation dose were significantly lower than the CAG group,with statistically significant differences(P<0.05).The blood creatinine,CysC,and BUN after surgery in the fusion group were significantly lower than those in the CAG group(P<0.05).At 12 months after surgery,the patency rate,stenosis rate,and occlusion rate of the grafts in the fu-sion group were 94.83%,2.29%,and 2.87%,respectively,which showed no statistically significant differences compared with 96.55%,0.57%,and 2.87%in the CAG group(P>0.05).The proportion of images with excellent quality in the fu-sion group was 94.83%,which was significantly higher than 84.48%in the CAG group,and the proportions of images with good and moderate quality were 5.17%and 0,respectively,which were significantly lower than 10.92%and 4.59%in the CAG group,with statistically significant differences(P<0.05).Conclusion CTA combined with CAG fusion technology can effectively improve image quality,improve postoperative heart,liver,and kidney function,reduce the oc-clusion rate of the grafts,which can provide reference basis for clinical evaluation of postoperative patency of the grafts and help formulate targeted intervention plans.