Aintablian A, Hamby R I, Hoffman I, Hartstein M L, Wisoff B G
J Electrocardiol. 1976;9(4):321-7. doi: 10.1016/s0022-0736(76)80024-6.
New Q waves were observed in 35 (11%) of 321 patients undergoing saphenous vein bypass grafting with an overall mortality rate of 1.1%. Twenty-eight (80%) had postoperative arteriograms and ventriculograms and are reported. Ventricular venting was used intra-operatively in 17 patients and atrial venting in 11. The incidence of new Q wave was 22% in patients with ventricular venting and 5.5% in those with atrial venting (p less than 0.05). Complete or incomplete revascularization did not affect the incidence of new Q waves. New Q waves appeared in a zone of myocardium supplied by a grafted artery in all except two patients with ventricular venting in whom Q waves occurred within the zone of myocardium supplied by diseased ungrafted vessels. In the ventricular venting group, seven (41%) demonstrated an improved or unchanged postoperative ventriculogram and ten (59%) had deteriorated ventriculograms. In 11 patients with atrial venting, nine (82%) showed improved or unchanged postoperative ventriculograms and two (18%) had deteriorated ventriculograms. Ventricular venting patients with improved or unchanged postoperative ventriculograms had 7% graft closure as compared to 5% of those with atrial venting (pNS). Graft closure rate was 44% in ventricular venting and 20% (pNS) of patients with atrial venting who had deteriorated left ventriculograms. These findings indicate poor correlation between new Q waves and graft closure. Improved postoperative ventriculograms corrleated well with graft patency despite new Q waves. The etiology of new post bypass graft Q waves are varied. They include ventricular trauma and conduction delays resulting from surgery or venting, as well as infarction. This may be due to compromised arterial inflow either in nonoperated vessels or in the vessels distal to the anastomosis with patent grafts, or due to occluded grafts.
在321例行大隐静脉搭桥术的患者中，有35例（11%）观察到新出现的Q波，总体死亡率为1.1%。28例（80%）患者进行了术后动脉造影和心室造影并予以报道。17例患者术中采用心室排气，11例采用心房排气。采用心室排气的患者中新出现Q波的发生率为22%，采用心房排气的患者为5.5%（p<0.05）。完全或不完全血运重建不影响新Q波的发生率。除2例采用心室排气的患者外，所有新出现Q波的患者其Q波均出现在移植动脉供血的心肌区域，这2例患者的Q波出现在未移植的病变血管供血的心肌区域。在心室排气组中，7例（41%）患者术后心室造影显示改善或无变化，10例（59%）患者的心室造影恶化。在11例采用心房排气的患者中，9例（82%）术后心室造影显示改善或无变化，2例（18%）患者的心室造影恶化。术后心室造影改善或无变化的心室排气患者的移植血管闭塞率为7%，而心房排气患者为5%（p无统计学意义）。左心室造影恶化的心室排气患者的移植血管闭塞率为44%，心房排气患者为20%（p无统计学意义）。这些发现表明新出现的Q波与移植血管闭塞之间相关性较差。尽管有新出现的Q波，但术后心室造影改善与移植血管通畅性良好相关。搭桥术后新出现Q波的病因多种多样。包括手术或排气导致的心室创伤和传导延迟，以及梗死。这可能是由于未手术血管或与通畅移植血管吻合口远端血管的动脉血流受损，或由于移植血管闭塞所致。
