负荷心肌造影对冠状动脉旁路移植术后心肌微循环的评价  

Assessment of microcirculation after coronary artery bypass surgery using dobutamine stress myocardial contrast ech- ocardiography

作　　者：刘畅[1] 修春红[2] 肖喜刚[3] 朱凯[3] 徐磊[1] 马丽园[1] 盂维鑫 刘宏宇[1] 

机构地区：[1]哈尔滨医科大学附属第一医院心血管外科,150001 [2]哈尔滨医科大学附属第一医院心脏彩超室,150001 [3]哈尔滨医科大学附属第一医院CT影像科,150001

出　　处：《中华胸心血管外科杂志》2016年第3期155-158,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：黑龙江省青年科学基金项目（QC2012C093）

摘　　要：目的应用负荷心肌造影对冠状动脉旁路移植（CABG）术后近期心肌微循环的评价预测远期心肌供血情况。方法2011年1月至2013年2月选取同一术者完成的CABG患者110例。术后2周行冠状动脉CTA及负荷心肌造影检查，记录患者负荷心肌造影时心肌缺血的发生情况。术后1年复查冠状动脉CTA及超声心动图，记录患者心绞痛的发生情况。排除旁路移植血管闭塞及重度狭窄患者。评价以术后2周负荷心肌造影预测术后1年患者心绞痛发生的准确性。结果以CABG术后2周多巴酚丁胺负荷心肌造影预测术后1年患者心绞痛的发生的准确性为92．22％（83／90），敏感性为81．82％（9／11），特异性为93．67％（74／79）。结论CABG术后近期负荷心肌造影可以对远期心肌供血情况进行很好的预测。Objective To evaluate the myocardial microcirculation 2 weeks after coronary artery bypass grafting（CABG） and predict the state of myocardial blood supply 1 year postoperation. Methods From Jan 2011 to Feb 2013 110 patients with coronary heart disease underwent CABG at our institution following the same surgical protocol. 256-slice muhislice computed tomography angiography（MSCTA） was done to evaluate graft patency 2 weeks and 1 year after CABG. The patients with ob- structed grafts and severe graft stenosis were excluded. Dobutamine stress myocardial contrast eehocardiography（DSMCE） was done to assess the microcirculation 2 weeks after CABG and the accurace of myocardial ischemia was recorded. These patients were followed up 1 year after CABG and patients with angina were recorded. Assessment of microcirculation by DSMCE 2 weeks postoperation was analyzed for the accuracy to predict angina 1 year after CABG. Results The accuracy of DSMCE 2 weeks af- ter CABG for predicting myocardial ischemia 1 year after CABG was 83/90 （92.22%）, the sensibility and specificity was 9/11 （81.82%） and 74/79（93.67% ）, respectively. Conclusion Assessment of microcirculation after CABG using DSMCE in the near future can predict the myocardial blood supply well in a long term postoperation.

关 键 词：冠状动脉旁路移植术 心肌微循环 负荷心肌造影 

分 类 号：R654.2[医药卫生—外科学]