非体外循环下左乳内动脉、桡动脉全动脉化冠脉旁路移植术的流量探讨  

Flow study of grafts in off-pump coronary artery bypass grafting using left internal mammary artery and radial artery anastomosis

作　　者：董明亮[1] 李清宝[1] 李德才[1] 王安彪[1] 范全心[1] 李勇[1] 訾捷[1] 

机构地区：[1]山东大学附属省立医院心脏外科,济南250021

出　　处：《山东大学学报（医学版）》2013年第4期47-50,共4页Journal of Shandong University:Health Sciences

摘　　要：目的探讨非体外循环下左乳内动脉﹑桡动脉"Y"形吻合,全动脉化冠状动脉旁路移植术前后,患者左乳内动脉的血流变化。方法 2008年10月至2011年8月,利用左乳内动脉和桡动脉"Y"形吻合,实施非体外循环下全动脉化冠状动脉旁路移植术42例。应用即时血流检测仪分别于左乳内动脉原位状态、左乳内动脉序贯吻合后、桡动脉序贯吻合后3个时间点测量左乳内动脉主干血流情况。运用SPSS13.0软件对相关数据进行统计学处理及分析。结果左乳内动脉原位状态血流与左乳内动脉序贯吻合后主干血流相比差异无统计学意义(P>0.05);桡动脉序贯后左乳内动脉主干血流与前两者相比差异有统计学意义(P<0.05)。所有左乳内动脉的即时血流测定(TTFM)波形图均表现为以舒张期为主的血流波形。术后24 h内有3例患者CK-MB升高,48 h降至正常;术后早期2例发生室性早搏,1例发生室颤;无围术期心肌梗死和低心排血量综合征等并发症发生;所有患者术后心绞痛症状均消失。结论带蒂原位左乳内动脉具有相当大的流量储备,其血流量在一定范围内与心肌供血面积有关;左乳内动脉、桡动脉"Y"形吻合冠状动脉旁路移植术,符合全心脏再血管化的血流要求。Objective To observe the bloodstream change of patients＇ left internal mammary artery （LIMA） during absolute arterial off-pump coronary artery bypass grafting （CABG） with ＂Y＂-type anastomosis of LIMA and radial ar- tery. Methods From October, 2008 to August, 2010, 42 patients underwent absolute arterial off-pump CABG with ＂Y＂ -type anastomosis of LIMA and radial artery were included in this study. LIMA＇ s blood flow was measured with Medi-stim Butterfly Flowmeter when LIMA was in situ, when LIMA was anastomosed sequentially, and when radial ar- tery was anastomosed sequentially. SPSS13. 0 statistic software was used for analysis. Results The blood flow of LI- MA after sequential anastomosis was not significantly different from that of in situ. The blood flow of LIMA after se- quential anastomosis of radial artery was significantly different from that of in situ and after sequential anastomosis of LIMA. The TTFM oscillogram of all LIMA mainly showed in the blood wave of diastole period. After operation, CK- MB of 3 patients was higher in 24 hours, and was reduced to normal level in 48 hours. Ventricular premature beat hap- pened in 2 patients, and ventricular fibrillation happened in 1 patient. No perioperative myocardial infarction or low car- diac output syndrome occurred. And all the patients got rid of angina after operation. Conclusion The blood flow of LIMA, which has a considerable flow reserve, has a certain relationship with its blood-supply area. And CABG with ＂Y＂-type anastomosis of LIMA and radial artery can revascularize the heart.

关 键 词：冠状动脉旁路移植 非体外循环 乳内动脉 桡动脉 

分 类 号：R654.2[医药卫生—外科学]