CAJ | 학술논문

目的探讨桡动脉在65岁以上老年患者冠状动脉旁路移植术(CABG)中的应用效果.方法 2000年1月至2007年3月利用桡动脉对322例65岁以上老年冠状动脉心脏病患者实施CABG,观察围手术期情况和术后远期效果.结果共取桡动脉344支,300例患者取单侧桡动脉,22例患者取双侧桡动脉.322例CABG中,远端吻合口共有974个,平均每例远端吻合口(3.0±0.4)个,平均每例桡动脉远端吻合口(1.1±0.4)个.桡动脉桥单纯端侧吻合321次,序贯吻合7次,利用桡动脉行T型桥或Y型桥16次.桡动脉近端直接吻合于主动脉328次,吻合于左胸廓内动脉9次,吻合于大隐静脉7次.桡动脉远端吻合于右冠状动脉系统234次,钝缘支95次,对角支/中间支22次.仅13例桡动脉取材处出现一过性感觉异常.围手术期无心肌梗死发生.住院期间7例患者(2.2%)死亡.平均随访(46.5±6.7)个月(12～81个月),患者全部存活.73例患者术后复查冠状动脉造影,复查时间为术后(47.5±11.2)个月(22-73个月),结果示桡动脉桥均通畅.结论在老年CABG患者中选用桡动脉是安全有效的.
목적 탐토뇨동맥재65세이상노년환자관상동맥방로이식술(CABG)중적응용효과.방법 2000년1월지2007년3월이용뇨동맥대322례65세이상노년관상동맥심장병환자실시CABG,관찰위수술기정황화술후원기효과.결과 공취뇨동맥344지,300례환자취단측뇨동맥,22례환자취쌍측뇨동맥.322례CABG중,원단문합구공유974개,평균매례원단문합구(3.0±0.4)개,평균매례뇨동맥원단문합구(1.1±0.4)개.뇨동맥교단순단측문합321차,서관문합7차,이용뇨동맥행T형교혹Y형교16차.뇨동맥근단직접문합우주동맥328차,문합우좌흉곽내동맥9차,문합우대은정맥7차.뇨동맥원단문합우우관상동맥계통234차,둔연지95차,대각지/중간지22차.부13례뇨동맥취재처출현일과성감각이상.위수술기무심기경사발생.주원기간7례환자(2.2%)사망.평균수방(46.5±6.7)개월(12～81개월),환자전부존활.73례환자술후복사관상동맥조영,복사시간위술후(47.5±11.2)개월(22-73개월),결과시뇨동맥교균통창.결론 재노년CABG환자중선용뇨동맥시안전유효적.
Objective To investigate the effect of autologous radial artery(RA)on coronary artery bypass grafting(CABG)in the elderly aged 65 years and older. Methods Three hundreds and twenty-two patients aged 65 years and older underwent CABG with autologous RA from January 2000 to March 2007.Peri-operative complication and mortality were observed and follow-up was performed.Results Three hundreds and forty-four RA grafts including 300 cases of single and 22 cases of bilateral RA were collected.The total number of distal anastamoses was 974,with the mean of(3.0±0.4).,The mean of RA distal anastamoses was(1.1 ± 0.4).There were 321 single,16 Y or T composite and 7 sequential grafts of RA constructed.The distal end of RA was anastomosed to right coronary artery system for 234 times,to obtuse marginal for 95 times,to diagonal or intermediate ramous artery for 22 times.The proximal end of RA was anastomosed to aorta for 328 times,to left internal mammary artery for 9 times and to saphenous vein for 7 times.Only 13 patients manifested transient parethesia in the area of radial aspect of thumb and no other complication occurred in the forearm. During hospitalization,7 patients died. No patient died after the follow-up of(46.5±6.7)months.Seventy-three patients were performed with coronary angiography postoperatively.It was showed by coronary angiography that all RA conduits were patent after the duration of(47.5±11.2)months after CABG.Conclusion Utilization of RA to CABG in the elderly is safe and effective.