冠状动脉旁路移植术治疗左前降支心肌桥的临床观察
发布时间：2018-08-31 14:37
【摘要】：背景与目的：心肌桥作为一种独立的冠状动脉病变,可以引起多种心血管系统疾病甚至心源性猝死等不良心血管事件。针对药物控制不满意的心肌桥患者,可以考虑行内科介入和外科手术治疗。但近些年的研究表明,内科介入治疗心肌桥往往无法取得较为满意的治疗效果。而外科治疗心肌桥的手段主要有心肌松解术和冠状动脉旁路移植术。本文总结并分析心肌桥的临床特点,探讨冠状动脉旁路移植术治疗心肌桥的临床疗效。方法：选取2008年6月至2014年4月于安徽医科大学第一附属医院心脏外科行冠状动脉旁路移植术治疗的冠状动脉心肌桥患者共28例,男13例,女15例。所有病患者术前常规行冠状动脉造影检查,均提示前降支心肌桥,收缩期狭窄70%～95%,其中单纯心肌桥11例,合并瓣膜病4例,合并先天性心脏病5例,合并冠心病8例。非体外循环不停跳下完成冠脉搭桥术18例,体外循环心脏停跳下完成10例；其中前降支选取左乳内动脉血管桥23例,大隐静脉桥5例。结果：1例因术后再发心梗死亡,1例出院6月内再发心绞痛,服药控制良好,其余26例冠状动脉心肌桥行外科治疗获成功,患者心绞痛等症状明显改善,心电图提示心肌缺血明显改善,室壁运动改善有20例,21例术后3-6个月复查冠状动脉CT,均未发现桥血管狭窄。结论：对于心肌桥收缩期狭窄70%及有临床症状的患者,冠状动脉旁路移植术是可靠有效的。
[Abstract]:Background & AIM: as an independent coronary artery disease, myocardial bridge can cause a variety of cardiovascular diseases, including sudden cardiac death and other adverse cardiovascular events. Medical intervention and surgical treatment may be considered for patients with myocardial bridge who are not satisfied with drug control. However, recent studies have shown that interventional treatment of myocardial bridge is often unable to achieve satisfactory results. The surgical treatment of myocardial bridge mainly consists of myocardial release and coronary artery bypass grafting. This article summarizes and analyzes the clinical features of myocardial bridge, and discusses the clinical effect of coronary artery bypass grafting (CABG) in the treatment of myocardial bridge. Methods: from June 2008 to April 2014, 28 patients (13 males and 15 females) underwent coronary artery bypass grafting (CABG) in the Department of Cardiac surgery, first affiliated Hospital of Anhui Medical University. All the patients were examined by coronary angiography before operation. The results showed that the anterior descending branch of myocardial bridge was 70 and 95%, including 11 cases of simple myocardial bridge, 4 cases of valvular disease, 5 cases of congenital heart disease and 8 cases of coronary heart disease. Coronary artery bypass grafting was performed in 18 cases and cardiopulmonary bypass in 10 cases, including 23 cases of left internal mammary artery graft and 5 cases of great saphenous vein graft. Results one patient died of recurrent myocardial infarction and one patient died of recurrent angina pectoris within 6 months of discharge. The medication was well controlled. The remaining 26 cases had successful surgical treatment of myocardial bridge of coronary artery, and the symptoms of angina pectoris were obviously improved. Electrocardiogram showed that myocardial ischemia was obviously improved and ventricular wall motion was improved in 20 cases. Coronary artery stenosis was not found in 20 cases after 3 to 6 months of coronary artery CT,. Conclusion: coronary artery bypass grafting is reliable and effective for 70% of patients with myocardial bridge stenosis and with clinical symptoms.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2
[Abstract]:Background & AIM: as an independent coronary artery disease, myocardial bridge can cause a variety of cardiovascular diseases, including sudden cardiac death and other adverse cardiovascular events. Medical intervention and surgical treatment may be considered for patients with myocardial bridge who are not satisfied with drug control. However, recent studies have shown that interventional treatment of myocardial bridge is often unable to achieve satisfactory results. The surgical treatment of myocardial bridge mainly consists of myocardial release and coronary artery bypass grafting. This article summarizes and analyzes the clinical features of myocardial bridge, and discusses the clinical effect of coronary artery bypass grafting (CABG) in the treatment of myocardial bridge. Methods: from June 2008 to April 2014, 28 patients (13 males and 15 females) underwent coronary artery bypass grafting (CABG) in the Department of Cardiac surgery, first affiliated Hospital of Anhui Medical University. All the patients were examined by coronary angiography before operation. The results showed that the anterior descending branch of myocardial bridge was 70 and 95%, including 11 cases of simple myocardial bridge, 4 cases of valvular disease, 5 cases of congenital heart disease and 8 cases of coronary heart disease. Coronary artery bypass grafting was performed in 18 cases and cardiopulmonary bypass in 10 cases, including 23 cases of left internal mammary artery graft and 5 cases of great saphenous vein graft. Results one patient died of recurrent myocardial infarction and one patient died of recurrent angina pectoris within 6 months of discharge. The medication was well controlled. The remaining 26 cases had successful surgical treatment of myocardial bridge of coronary artery, and the symptoms of angina pectoris were obviously improved. Electrocardiogram showed that myocardial ischemia was obviously improved and ventricular wall motion was improved in 20 cases. Coronary artery stenosis was not found in 20 cases after 3 to 6 months of coronary artery CT,. Conclusion: coronary artery bypass grafting is reliable and effective for 70% of patients with myocardial bridge stenosis and with clinical symptoms.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2
【参考文献】
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1 王健,钱菊英,周月明,祝X≈，
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