二维多普勒评价药物对旁路移植术后和原位乳内动脉血流的作用  

The evaluation of effects of drugs on hemodynamics in the implanted and non-implanted internal mammary arteries using two-dimension Doppler method

作　　者：张玉萍[1] 姬尚义[1] 

机构地区：[1]深圳市孙逸仙心血管医院,深圳市心血管病研究所,518202

出　　处：《岭南心血管病杂志》2005年第2期76-78,共3页South China Journal of Cardiovascular Diseases

摘　　要：目的比较硝酸甘油及硝苯地平对原位右乳内动脉(rightinternalmammaryartery,RIMA)及冠状动脉旁路移植术后的左乳内动脉(leftinternalmammaryartery,LIMA)血流特性的影响,为冠状动脉旁路移植术后用药提供药理学的依据。方法对11例冠状动脉旁路移植术患者术后1周在胸骨旁左右第1肋间用4.5mHz和3.7mHz的多普勒传感器测定RIMA与LIMA的直径、时间流速积分和心输出量,并分别求出血流量、全身循环阻力及局部血管阻力,观察这些指标在舌下含服硝酸甘油及硝苯地平前后的变化。结果舌下含服硝酸甘油及硝苯地平能引起平均动脉压及全身循环阻力不同程度的下降(P<0.05),两药间的数值差异无统计学意义(P>0.05)。用硝苯地平后心输出量在增加,差异有统计学意义(P<0.05);用硝酸甘油后有增加,但差异无统计学意义(P>0.05)。用硝酸甘油后RIMA的直径增加,差异有统计学意义(P<0.05),而血流量及局部血管阻力无明显变化;用硝苯地平后RIMA的直径及血流量均明显增加,局部血管阻力下降,差异有统计学意义(P<0.05),且用硝苯地平后RIMA的血流量较用硝酸甘油后增加更明显,差异有统计学意义(P<0.05),相对应局部血管阻力下降更加明显,差异有统计学意义(P<0.05)。LIMA的直径及血流量在用硝酸甘油和硝苯地平后均明显增加,而用硝苯地平后增加更加显著,差异有统计学意义(P<0.05),局部血管阻力在用硝酸甘油和硝苯地平后明显下降,以硝苯地平为更显著,差异有统计学意义(P<0.05)。结论①硝酸甘油和硝苯地平对冠状动脉旁路移植术后的LIMA的作用是增加直径及血流量,减低局部血管阻力,而以硝苯地平作用更强;②原位RIMA只受硝苯地平的影响,说明硝苯地平扩血管作用更强;③两药增加血流量是通过扩张血管而不是增加时间流速积分发挥作用的。Objectives To evaluate the effects of vasoactive drugs on the hemodynamics in the implanted and non-implanted internal mammary arteries(IMA). Methods CABG patients with implanted left IMA (LIMA) and the intact right IMA(RIMA) were studied on the 5th to 7th postoperative day. Measurements were obtained pre-and post- sublingual nitroglycerine (NTG:0.7mg) and pre- and post-sublingnal nifedipine (NIF:10 mg). Diameter(D) and time velocity integral (TVI) were measured at the right and left 1st parasternal intercostal space utilizing 4.5 mHz (imaging) and 3.7 mHz (Doppler) transducers. Volume flow (F) was calculated as the product of TVI, D and, heart rate (HR), Cardiac output (CO) was derived by echo. Systemic and local vascular resistance (SVR, LVR) were calculated according to mBP and CO or F respectively. Results The similar changes of systemic circulatory indices were observed after the sublingual of both NTG and NIF. There was significant decrease of blood pressure (BP) and SVR (P<0.05), significant increase of HR and CO (P<0.05), while no significant change of TVI. The similar changes of their effects on both RIMA and LIMA were also observed: except that NIF could increase the F of RIMA and the D of LIMA more than NTG. This implied that NIF may be a more potent vessel dilator than NTG. On the other hand, NTG could significantly increase the flow ratio of diastolic/systolic of the implanted LIMA than NIF, which indicated that NTG was more suitable than NIF to be used post CABG for blood supply to myocardium. Conclusions ①Both NTG and NIF can increase D and F, decrease LVR of the cardiac conduit LIMA. ②NIF is a more potent dilator of LIMA and its vascular bed than NTG. ③The peripheral conduit RIMA is affected by NIF only.④Increasing F by both drugs depends on vasodilation rather than on increasing TVI.

关 键 词：二维多普勒 硝酸甘油 硝苯地平 乳内动脉 血管阻力 血流量 

分 类 号：R331.37[医药卫生—人体生理学]