非体外循环冠状动脉旁路移植术围手术期心肌梗死发生率与移植血管血流量的关系  

Impact of Graft Flow on the Incidence of Perioperative Myocardial Infarction in Off-pump Coronary Artery Bypass Grafting

作　　者：董士勇[1] 李一帆[1] 宋波[1] 杜迎利[1] 肖锋[1] 李岩[1] 

机构地区：[1]北京大学第一医院心脏外科,北京100034

出　　处：《中国胸心血管外科临床杂志》2011年第6期498-502,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨冠状动脉旁路移植术(CABG)中移植血管血流量与围手术期心肌梗死(MI)发生率之间的关系,为临床提供借鉴。方法采集2010年1～6月在北京大学第一医院连续58例因冠心病接受单纯择期非体外循环冠状动脉旁路移植术(OPCAB)患者的临床资料。术中均采用左乳内动脉(LIMA)吻合于左前降支(LAD),其他靶血管则以大隐静脉(SV)作为旁路移植血管,在关胸前循环状态稳定条件下,应用瞬时流量测定技术测量各移植血管的血流量,并计算移植血管总血流量。根据术后是否发生围手术期MI,将患者分成两组:MI组11例,其中男7例,女4例;年龄67.4±10.3岁;非MI组,47例,其中男38例,女9例;年龄63.3±9.9岁。分析两组患者术前及术中的相关危险因素。结果 MI组与非MI组的手术时间差异无统计学意义(205.4±59.6min vs.183.4±32.4min,t=1.691,P=0.096)。MI组与非MI组移植血管数量(3.00±1.00支vs.2.96±0.78支,t=0.154,P=0.878)、LIMA-LAD移植血管血流量(15.40±11.37ml/min vs.16.50±10.83ml/min,t=0.301,P=0.764)差异均无统计学意义;MI组与非MI组移植血管总血流量(41.03±19.50ml/min vs.64.09±32.44ml/min,t=2.254,P=0.028)差异有统计学意义。移植血管总血流量<48.5ml/min为发生MI的危险因素[OR=4.706,95%CI(1.099,20.147)]。结论移植血管总血流量可在一定程度上预测CABG后急性心肌缺血事件的发生,总血流量<48.5ml/min的患者术后发生围手术期MI的概率将明显增加。Abstract： Objective To investigate the relationship between graft flow and incidence of perioperative myocardial infarction （MI） in coronary artery bypass grafting （CABG）. Methods Between January 2010 and June 2010, 58 consecutive patients with coronary artery disease who underwent off-pump CABG in the First Hospital of Peking University were enrolled in this study. An anastomosis between left internal mammary arteries （LIMA） and left anterior descending coronary artery （LAD） were performed. And saphenous vein （SV） grafts were used as bypass grafts. Graft flow was measured intraoperatively using a transit time flowmeter, and the total graft flow of each patient was calculated as a parameter of myocardial revascularization. The 58 patients were divided into a MI group and a non- MI group retrospectively. There were 11 patients in the MI group, including 7 males and 4 females, with an average age of 67.4±10.3 years. There were 47 patients in the non-MI group, 38 males and 9 females, with a mean age of 63.3±9.9 years. The graft flow of the two groups was tested and compared, and the preoperative variables were compared. Results There was no statistically significant difference in operation time （205. 4 ± 59. 6 min versus 183.4±32.4 min, t= 1. 691, P=0. 096） between the two groups. There were also no statistical differences in the average number of grafts （3.00±1.00 branches versus 2.96±0.78 branches, t=0. 154, P=0. 878） or LIMA LAD flow （15. 404±11.37 ml/minversus 16. 50±10. 83 ml/min, t=0.301, P=0.764） between the two groups. However, a significant difference was found in the total graft flow between the two groups （41. 03 ±19. 50 ml/min versus 64.09±32.44 ml/min, t=2. 254, P=0. 028）, with lower total graft flow in the MI group. Further analysis showed that a total graft flow 48.5 ml / min was a risk factor for MI （ odds ratio 4. 706, 95confidence interval 1. 099 to20. 147）. Conclusion Total graft flow could be used to predict the occurrence of perioperative myoca

关 键 词：冠状动脉旁路移植术 移植物流量 心肌梗死 心肌再血管化 

分 类 号：R654.2[医药卫生—外科学]