摘要
目的总结自体桡动脉材料在冠脉旁路移植术（CABG）中的采集、应用和早中期疗效评价。方法分析196例冠状动脉搭桥者临床资料,术前用Allen试验判定能否获取桡动脉,取材时严格遵守“不接触”原则,与伴行静脉一起取下,离断后向腔内注射肝素化罂粟碱液并置入血管保护液中备用。共取材172根,完成远端吻合口184个,远端分别吻合到冠状动脉第一对角支、第二对角支、左旋支、左室后支、右冠、右室后支,近端均吻合在升主动脉上。术后常规应用Ca^2＋拮抗剂3-6个月。结果围手术期死亡8例,自动出院3例。康复者心绞痛消失,心功能显著改善,全组无围手术期心肌梗死及桡动脉痉挛现象发生。无围手术期出血、栓塞等合并症,无手臂缺血、坏死等。结论桡动脉是良好的桥血管材料,可常规用于冠脉旁路移植术;Allen试验是判定能否采集桡动脉的重要标准;取材时严格遵循“不接触”原则、术后用Ca^2＋拮抗剂预防桡动脉痉挛是保证其发挥良好功能的关键。
Objective To summarizing the harvesting, applying experience and evaluation early-middle clinical outcome of self-radial artery in coronary artery bypass graft（CABG）. Methods Analysis the patients records of 196 patients received CABG with their self-radial arteries（RAs）.Before operation, using Allen-test to determine the safety whether to harvest their RAs. While harvesting, no touch technique were abided, the companied veins were harvested together. After cutted down, papaverine solution was injected intraluminally into the free RA grafts before they were stored in vessel protection solution. 172 RA grafts were harvested, 184 anastomoses were completed. All their remote ends were anastomosed onto the 1st diagonal、2nd diagonal、left circumflex、post branches of left ventricular、right coronary、post descending branches. All the proximal ends were anastomosed onto ascend artery. Calcium channel-blockers were routinely used for 3-6 months after operation. Results 8 patients died in hospital, 3 patients left hospital voluntarily, the others recovered, not suffering from angina pectoris any more. Myocardial function was improved. No perioperation myocardial infarction occurred. No vascular spasm occurred. No bleeding, no embolism, no ischemic or necrosis phenomenon of forearm were found. Conclusion RAs should be routinely used in CABG because of their favourable characteristics. Allen-test is the significant standard to determine whether to harvest. No-touch harvesting technique and using of calcium channel-blockers are essential to guarantee their function.
出处
《华中科技大学学报（医学版）》
CAS
CSCD
北大核心
2008年第4期517-519,共3页
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
关键词
桡动脉
桥血管移植物
冠脉旁路移植术
radial artery, vessel bridge graft, coronary artery bypass graft
