上海交通大学学报（医学版）

上海交通大学学报(医学版) ›› 2020, Vol. 40 ›› Issue (07): 936-942.doi: 10.3969/j.issn.1674-8115.2020.07.012

• 论著·临床研究 • 上一篇    下一篇

定量血流分数指导冠状动脉外科血运重建的研究

朱云鹏1*，朱嘉希1*，张 嵬2，陈安清1，王 哲1，刘 俊1，周 密1，叶晓峰1，涂圣贤3#，赵 强1#   

  1. 1. 上海交通大学医学院附属瑞金医院心血管外科，上海 200025；2. 复旦大学公共卫生学院生物统计学教研室，上海 200032；3. 上海交通大学生物医学工程学院Med-X 研究院，上海 200240
  • 出版日期:2020-07-28 发布日期:2020-09-23
  • 通讯作者: 赵 强，电子信箱：zq11607@rjh.com.cn。涂圣贤，电子信箱：sxtu@sjtu.edu.cn。#为共同通信作者。
  • 作者简介:朱云鹏（1983—），男，主治医师，博士生；电子信箱：zyp12220@rjh.com.cn。朱嘉希（1991—），男，住院医师，博士；电子信箱：zjx12572@rjh.com.cn。*为共同第一作者。
  • 基金资助:
    上海申康医院发展中心临床科技创新项目（SHDC12018X11）；上海交通大学“医工交叉基金”项目（YG2016ZD09）；上海交通大学医学院附属瑞金医院临床研究资助项目（2018CR001）。

Study of quantitative flow ratio-guided surgical coronary revascularization

ZHU Yun-peng1*, ZHU Jia-xi 1*, ZHANG Wei 2, CHEN An-qing1, WAGN Zhe 1, LIU Jun1, ZHOU Mi 1, YE Xiao-feng1, TU Sheng-xian 3#, ZHAO Qiang1#   

  1. 1. Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; 2. Department of Biostatistics, Fudan School of Public Health, Shanghai 200032, China; 3. Med-X Institute, Shanghai Jiao Tong University School of Biomedical Engineering, Shanghai 200240, China
  • Online:2020-07-28 Published:2020-09-23
  • Supported by:
    Clinical Science Innovation Project of Shanghai Shenkang Hospital Development Center ( SHDC12018X11); Shanghai Jiao Tong University “Med-X Foundation” Project (YG2016ZD09); Clinical Research Project of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine (2018CR001).

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摘要： 目的·分析应用定量血流分数（quantitative flow ratio，QFR）技术指导冠状动脉外科血运重建策略的初步临床结果，探索其可行性与安全性。方法·纳入2018年1月—2019年6月上海交通大学医学院附属瑞金医院心血管外科行择期心脏外科手术的82例患者，对术前冠状动脉造影目测法提示狭窄≥50%的病变血管行QFR分析。QFR≤0.8判断为阳性，提示存在冠状动脉病变导致的心肌缺血，建议行冠状动脉旁路血管移植术（coronary artery bypass grafting，CABG）。对患者的基线资料、手术数据及初步临床结果进行总结。结果·82例患者共计174支冠状动脉接受QFR分析，其中53支血管（30.5%）为QFR阳性（≤0.8），其余121支（69.5%）为QFR阴性(>0.8)。根据QFR重新对血运重建进行决策后，39例（47.6%）患者的62支（35.6%）血管按原手术计划进行针对原发病的心脏外科手术和同期CABG。其余43例患者（52.4%）的112支（64.4%）血管改变了血运重建策略或未行CABG；其中15例（18.3%）单纯冠状动脉粥样硬化性心脏病患者免于任何手术而出院。接受手术的67例患者中，术后30 d内全因死亡2例（3.0%），新发肾功能衰竭行血液透析治疗4例，围术期心肌梗死1例，脑卒中1例，未观察到非计划再次血运重建，累计发生复合主要不良临床事件6例（9.0%）。结论·QFR指导冠状动脉外科血运重建是可行的和安全的，可以减少不必要的CABG，其有效性尚待进一步随访和前瞻性临床研究验证。

关键词: 心脏外科手术, 冠状动脉旁路血管移植术, 心肌血流储备分数, 定量血流分数, 围术期临床结果

Abstract:

Objective · To analyze the feasibility, safety and preliminary clinical results of quantitative flow ratio (QFR)-guided surgical coronary revascularization. Methods · From Jan 2018 to June 2019 at the Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, patients undergoing elective cardiac surgery with any coronary stenosis ≥ 50%, evaluated by preoperative coronary angiography visualization, were enrolled consecutively. There were 82 patients with 174 coronary artery vessels. Coronary artery bypass grafting (CABG) was recommended with a QFR value ≤ 0.8. The data of baseline characteristics, surgical procedure and perioperative outcomes were collected and analyzed. Results · QFR analysis was successfully carried out in 82 patients and 174 coronary artery vessels. QFR was detected positive ( ≤ 0.8) in 53 vessels (30.5%) and negative (>0.8) in the remaining 121 vessels (69.5%). As guided with QFR, 39 patients (47.6%) with 62 vessels (35.6%) proceeded to surgery for primary heart disease with concomitant CABG as planned, while the remaining 43 patients (52.4%) with 112 vessels (64.4%) changed revascularization strategy or spared CABG. Fifteen patients with simple coronary artery disease avoided CABG and discharged. Among the remaining 67 patients operated on, there were 2 deaths, 4 hemodialysis for new renal failure, 1 perioperative myocardial infarction and 1 stroke within 30 d. No unplanned revascularization was observed. The composite adverse events occurred in 6 cases (9.0%). Conclusion · QFR-guided surgical coronary revascularization is feasible and safe. This strategy could reduce the unnecessary bypass grafting. Further follow-up and prospective clinical trials are warranted to evaluate the effectiveness.

Key words: cardiac surgery, coronary artery bypass grafting, fractional flow reserve, quantitative flow ratio, perioperative clinical results

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