目的 分析冠狀動脈旁路移植術(shù)(CABG)后1年移植血管通暢率及危險因素?!》椒ā∏罢靶赃B續(xù)納入哈爾濱醫(yī)科大學(xué)附屬第一醫(yī)院2010年6~12月行CABG患者71例,其中男37例,女34例;年齡(59.8±7.7)歲,由同一術(shù)者主刀完成手術(shù),術(shù)后用標(biāo)準(zhǔn)藥物治療。術(shù)后1年行冠狀動脈256排多層螺旋CT檢查,根據(jù)移植血管通暢與否,將患者分為閉塞組(n=16)和通暢組(n=55)。收集術(shù)前、術(shù)中和術(shù)后隨訪資料,通過單因素分析和logistic多因素回歸分析篩選導(dǎo)致移植血管病變的危險因素。 結(jié)果 術(shù)后1年移植血管通暢率為91.0% (172/189)。單因素分析結(jié)果顯示,術(shù)前膽固醇水平(t=-2.389,P=0.017)、血管彌漫性病變(χ2=4.449,P=0.042)、靶血管直徑(t=5.064,P=0.000)、術(shù)后未規(guī)范服用抗血小板藥物(χ2=10.175,P=0.008)是移植血管病變的潛在危險因素。logistic多因素回歸分析結(jié)果顯示,靶血管狹窄 [RR=0.014,95% CI (0.001,0.228),P=0.003]和術(shù)后未規(guī)范服用抗血小板藥物[RR=13.375,95% CI (1.075,175.536),P=0.044]是移植血管病變危險因素?!〗Y(jié)論 CABG患者術(shù)后1年移植血管通暢率較高,移植血管通暢率與靶血管狹窄及術(shù)后抗血小板藥物的規(guī)范服用相關(guān)。
引用本文: 劉暢,肖喜剛,王柏春,吳丹,徐磊,劉宏宇. 冠狀動脈旁路移植術(shù)后移植血管通暢率的影響因素分析. 中國胸心血管外科臨床雜志, 2012, 19(6): 606-609. doi: 復(fù)制
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2. | Henderson ER, Pocock SJ, Sharp SJ, et al. Long-term results of RITA-1 trial clinical and cost comparisons of coronary angioplasty and coronary-artery bypass grafting. Randomised Intervention Treatment of Angina. Lancet, 1998, 352 (9138):1419-1425. |
3. | 宋瑋, 金叔宣, 杜勇平, 等.16排CT對冠狀動脈橋血管病變評估的臨床應(yīng)用價值.中華心血管病雜志, 2005, 33 (8):704-707.. |
4. | Yamamoto M, Kimura F, Niinami H, et al. Noninvasive assessment of off-pump coronary artery bypass surgery by 16-channel multidetector-row computed tomography. Ann Thorac Surg, 2006, 81 (3):820-827. |
5. | Pache G, Saueressig U, Frydrychowicz A, et al. Initial experience with 64-slice cardiac CT:non-invasive visualization of coronary artery bypass grafts. Eur Heart J, 2006, 27 (8):976-980. |
6. | Manninen HI, Jaakkola P, Suhonen M, et al. Angiographic predictors of graft patency and disease progression after coronary artery bypass grafting with arterial and venous grafts. Ann Thorac Surg, 1998, 66 (4):1289-1294. |
7. | Berger A, Maccarthy PA, Siebert U, et al. Long-term patency of internal mammary artery bypass grafts:relationship with preoperative severity of the native coronary artery stenosis. Circulation, 2004, 110 (11 Supp l1):II36-II40. |
8. | Goldman S, Copeland J, Moritz T, et al. Improvement in early saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy:results of a Veterans Administration Cooperative Study. Circulation, 1988, 77 (6):1324-1332. |
9. | Motwani JG, Topol EJ. Aortocoronary saphenous vein graft disease:pathogenesis, predisposition, and prevention. Circulation, 1998, 97 (9):916-931. |
10. | Gum PA, Kottke-Marchant K, Welsh PA, et al. A prospective, blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease. J Am Coll Cardiol, 2003, 41 (6):961-965. |
11. | Gurbuz AT, Zia AA, Vuran AC, et al. Postoperative clopidogrel improves mid-term outcome after off-pump coronary artery bypass graft surgery:a prospective study. Eur J Cardiothorac Surg, 2006, 29 (2):190-195. |
12. | Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med, 2001, 345 (7):494-502. |
13. | CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet,1996,348 (9038):1329-1339. |
14. | Cadroy Y, Bossavy JP, Thalamas C, et al. Early potent antithrombotic effect with combined aspirin and a loading dose of clopidogrel on experimental arterial thrombogenesis in humans. Circulation, 2000, 101 (24):2823-2828. |
15. | Fox KA, Mehta SR, Peters R, et al. Benefits and risks of the combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non-ST-elevation acute coronary syndrome:the Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (CURE) Trial. Circulation, 2004, 110 (10):1202-1208. |
16. | Gao G, Zheng Z, Pi Y, et al. Aspirin plus clopidogrel therapy increases early venous graft patency after coronary artery bypass surgery a single-center, randomized, controlled trial. J Am Coll Cardiol, 2010, 56 (20):1639-1643. |
17. | Goldman S, Zadina K, Moritz T, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery:results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol, 2004, 44 (11):2149-2156. |
18. | Mitka M. Beat goes on in “off-pump” bypass surgery:surgeon experience may be key to best outcome. JAMA, 2004, 291 (15):1821-1822. |
- 1. Garcia MJ, Lessick J, Hoffmann MH, et al. Accuracy of 16-row multidetector computed tomography for the assessment of coronary artery stenosis. J Am Med Assoc, 2006, 296 (4):403-411.
- 2. Henderson ER, Pocock SJ, Sharp SJ, et al. Long-term results of RITA-1 trial clinical and cost comparisons of coronary angioplasty and coronary-artery bypass grafting. Randomised Intervention Treatment of Angina. Lancet, 1998, 352 (9138):1419-1425.
- 3. 宋瑋, 金叔宣, 杜勇平, 等.16排CT對冠狀動脈橋血管病變評估的臨床應(yīng)用價值.中華心血管病雜志, 2005, 33 (8):704-707..
- 4. Yamamoto M, Kimura F, Niinami H, et al. Noninvasive assessment of off-pump coronary artery bypass surgery by 16-channel multidetector-row computed tomography. Ann Thorac Surg, 2006, 81 (3):820-827.
- 5. Pache G, Saueressig U, Frydrychowicz A, et al. Initial experience with 64-slice cardiac CT:non-invasive visualization of coronary artery bypass grafts. Eur Heart J, 2006, 27 (8):976-980.
- 6. Manninen HI, Jaakkola P, Suhonen M, et al. Angiographic predictors of graft patency and disease progression after coronary artery bypass grafting with arterial and venous grafts. Ann Thorac Surg, 1998, 66 (4):1289-1294.
- 7. Berger A, Maccarthy PA, Siebert U, et al. Long-term patency of internal mammary artery bypass grafts:relationship with preoperative severity of the native coronary artery stenosis. Circulation, 2004, 110 (11 Supp l1):II36-II40.
- 8. Goldman S, Copeland J, Moritz T, et al. Improvement in early saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy:results of a Veterans Administration Cooperative Study. Circulation, 1988, 77 (6):1324-1332.
- 9. Motwani JG, Topol EJ. Aortocoronary saphenous vein graft disease:pathogenesis, predisposition, and prevention. Circulation, 1998, 97 (9):916-931.
- 10. Gum PA, Kottke-Marchant K, Welsh PA, et al. A prospective, blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease. J Am Coll Cardiol, 2003, 41 (6):961-965.
- 11. Gurbuz AT, Zia AA, Vuran AC, et al. Postoperative clopidogrel improves mid-term outcome after off-pump coronary artery bypass graft surgery:a prospective study. Eur J Cardiothorac Surg, 2006, 29 (2):190-195.
- 12. Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med, 2001, 345 (7):494-502.
- 13. CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet,1996,348 (9038):1329-1339.
- 14. Cadroy Y, Bossavy JP, Thalamas C, et al. Early potent antithrombotic effect with combined aspirin and a loading dose of clopidogrel on experimental arterial thrombogenesis in humans. Circulation, 2000, 101 (24):2823-2828.
- 15. Fox KA, Mehta SR, Peters R, et al. Benefits and risks of the combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non-ST-elevation acute coronary syndrome:the Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (CURE) Trial. Circulation, 2004, 110 (10):1202-1208.
- 16. Gao G, Zheng Z, Pi Y, et al. Aspirin plus clopidogrel therapy increases early venous graft patency after coronary artery bypass surgery a single-center, randomized, controlled trial. J Am Coll Cardiol, 2010, 56 (20):1639-1643.
- 17. Goldman S, Zadina K, Moritz T, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery:results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol, 2004, 44 (11):2149-2156.
- 18. Mitka M. Beat goes on in “off-pump” bypass surgery:surgeon experience may be key to best outcome. JAMA, 2004, 291 (15):1821-1822.