冠状动脉旁路移植术后心绞痛的冠状动脉造影分析Arteriographic evaluation of graft patency in patients with reccurrence of angina after CABG
盖鲁粤,杨庭树,王禹,刘宏斌,孙志军,韩炜,杜洛山
摘要(Abstract)：
目的 了解自体血管和移植血管随时间产生的变化与心绞痛复发的关系 ,探讨治疗方法。方法 4 8例冠状动脉旁路移植 (CABG)术后的患者因心绞痛复查冠状动脉造影 ,检查自体血管和移植血管的情况。结果 4 8例患者中男性 4 2例 ,女性 6例 ,平均年龄 6 2 8± 9 9岁。CABG到冠状动脉造影时间 :1～ 6个月 4 7 9% (2 3 4 8) ;7～ 12个月 2 0 8% (10 4 8) ,1年以上者 31 3% (15 4 8)。 135支移植血管中 ,闭塞 33 3% (4 5 135 ) ,狭窄 5 9% (8 135 ) ;其中左乳内动脉 (LIMA)闭塞 2 8 6 % (10 35 ) ,吻合口狭窄 8 6 % (3 35 ) ,血流竞争不过自体血管 8 6 % (3 35 ) ;静脉桥狭窄 5 2 % (5 97) ,闭塞 35 1% (34 97)。 3例桡动脉搭桥中 2例有狭窄。心绞痛复发可能的原因 :移植血管病变 72 9% (35 4 8) ,自体血管病变加重 8 3% (4 4 8) ,再血管化不完全 12 5 % (6 4 8) ,移植血管在狭窄近端 1例 ,左锁骨下动脉起始部严重狭窄导致LIMA供血不足 1例。药物治疗 2 5例 ;自体血管介入治疗 15例 ,5例慢性闭塞失败 ;6例桥血管狭窄介入治疗成功 ;2例再CABG。结论 CABG术后仍可以复发心绞痛 ,复发的主要原因是移植血管病变 ,其次为自体血管病变加重 ,再血管化不完全 ,搭桥位置不正确。自体和移植血管狭窄性病
关键词(KeyWords)： 冠心病;冠状动脉造影;冠状动脉旁路移植术
基金项目(Foundation):
作者(Author): 盖鲁粤,杨庭树,王禹,刘宏斌,孙志军,韩炜,杜洛山
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