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

冯杰莉; 李昭屏; 张喆; 李丹; 刘丽娜

doi:10.13201/j.issn.1001-1439.2020.06.015

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

- 1. 北京大学第三医院心内科血管医学研究所国家卫健委心血管分子生物学与调节肽重点实验室分子心血管学教育部重点实验室心血管受体研究北京市重点实验室(北京, 100191);
- 2. 北京大学第三医院心外科
基金项目:
北京大学第三医院院临床重点项目青年项目（No：BYSY2015015）

详细信息

通讯作者: 李昭屏,E-mail:zhaoping1223@163.com

中图分类号: R541.4;R540.45

收稿日期: 2019-10-18

修回日期: 2020-04-10

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

- 1. Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital;NHK Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health;Key Laboratory of Molecular Cardiovascular Science, Ministry of Education;Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China;
- 2. Department of Surgical Cardiology, Peking University Third Hospital

More Information

Corresponding author: LI Zhaoping, E-mail: zhaoping1223@163.com

Received Date: 18 October 2019

Revised Date: 10 April 2020

摘要

摘要: 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，CFR_LAD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。
- 冠状动脉旁路移植术 /
- 左侧乳内动脉 /
- 冠状动脉血流储备 /
- 经胸多普勒超声心动图
Abstract: 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 CFR_bypassin all patients was 2.70 ± 0.82. The reverse flow of LAD in the proximal anastomotic site was found in 28 patients, and the CFR_LADwas 2.10±0.97.44 (41.12%) patients had CFR_bypass<2.5.The incidence of exertive chest pain in patients with CFR_bypass<2.5 was significantly higher than that in patients with CFR_bypass ≥ 2.5 (29.55%:7.94%, P=0.005).CFR_bypassin patients with hypertension was significantly lower than that in patients without hypertension[(2.52 ± 0.74):(3.02 ± 0.86), P=0.002], and CFR_bypassin 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 CFR_bypass(P < 0.05).Conclusion: Hypertension and diabetes mellitus were independent predictors for CFR of LIMA_bypass in the long term after CABG, and the incidence of exertive chest pain was high in patients with CFR_bypass< 2.5.
- coronary artery bypass grafting /
- left internal mammary artery /
- coronary flow reserve /
- transthoracic doppler echocardiography

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参考文献(14)

[1]	European Association for Percutaneous Cardiovascular Interventions(EAPCI).ESC Scientific Document Group.2018 ESC/EACTS Guidelines on myocardial revascularization[J].Eur Heart J, 2019, 40(2):87-165.
[2]	王保平, 孙余华.冠状动脉微血管功能障碍和微血管心绞痛[J].临床心血管病杂志, 2018, 34(10):957-960.
[3]	He GW, Taggart DP.Spasm inarterial grafts in coronary artery bypass grafting surgery[J].Ann Thorac Surg, 2016, 101(3):1222-1229.
[4]	李丽, 赵强, 盖鲁粤, 等.冠状动脉旁路移植术后移植血管的转归及影响因素分析[J].中国循环杂志, 2017, 32(2):128-131.
[5]	曾秋棠, 彭昱东.非阻塞缺血性冠状动脉疾病的诊疗进展[J].临床心血管病杂志, 2019, 35(5):391-394.
[6]	中华医学会心血管病学分会基础研究学组, 中华医学会心血管病学分会介入心脏病学组, 中华医学会心血管病学分会女性心脏健康学组, 中华医学会心血管病学分会动脉粥样硬化和冠心病学组.冠状动脉微血管疾病诊断和治疗的中国专家共识[J].中国循环杂志, 2017, 32(5):421-430.
[7]	Kaski JC, Crea F, Bernard J, et al.Reappraisal of ischemic heart disease:fundamental role of coronary microvascular dysfunction in the pathogenesis of angina pectoris[J].Circulation, 2018, 138(14):1463-1480.
[8]	Ford TJ, Rocchiccioli P, Good R, et al.Systemic microvascular dysfunction in microvascular and vasospastic angina[J].Eur Heart J, 2018, 39(46):4086-4097.
[9]	Honda K, Yuzaki M, Kaneko M.Functional evaluation of the myocardial ischemia after coronary artery bypass surgery using coronary flow velocity reserve in left ventricular hypertrophy[J].Semin Thorac Cardiovasc Surg, 2019, 31(2):166-173.
[10]	Ismail H, Onur G, Deniz O, et al.Coronary flow reserve in patients with left anterior descending artery-left internal mammary artery long patch plasty anastomosis:a prospective study[J].J Cardiothorac Surg, 2015, 10(1):51-55.
[11]	José SA, Jeane MT, Sandra NR, et al.The impact of ligation of proximal side branches on blood flow and functional status of the internal thoracic artery in coronary anastomosis[J].Echocardiography, 2016, 33(11):1656-1664.
[12]	邓勇志.CABG是糖尿病多支病变/左主干患者血运重建的不二选择-5年全因死亡率显著低于PCI[J].临床心血管病杂志, 2019, 35(6):487-490.
[13]	Picchi A, Limbruno U, Focardi M, et al.Increased basal coronary blood flow as a cause of reduced coronary flow reserve indiabetic patients[J].Am J Physiol Heart Circ Physiol, 2011, 301(6):2279-2284.
[14]	杜兰芳, 李昭屏, 李丹, 等.血压控制水平对高血压患者冠状动脉血流储备的影响[J].中华心血管病杂志, 2016, 44(5):421-425.