颈动脉狭窄程度对冠脉搭桥术中大脑动脉血流变化的影响  

The effect of carotid artery stenosis on cerebral blood flow in patients undergoing coronary artery bypass grafting

作　　者：刘飞[1] 徐东[1] 张科峰[1] 李洪利[1] 尚学斌[1] 刘燕晖[1] 姚青[1] 杨禹[1] 

机构地区：[1]首都医科大学宣武医院心脏科,北京100053

出　　处：《热带医学杂志》2016年第4期474-476,482,共4页Journal of Tropical Medicine

摘　　要：目的探讨体外循环下冠脉搭桥术中脑血流变化趋势及体外循环转机流量对脑血流的影响。方法选取51例冠心病患者,采集病史根据超声情况中颈动脉狭窄程度分组为:颈动脉狭窄≥50%设定为A组,颈动脉无狭窄或狭窄<50%设定为B组。在冠脉搭桥术中分别记录两组患者术前、麻醉后、体外循环时及停机时双侧大脑中动脉(MAC)血流峰值流速;同时观察两组患者体外循环时冠脉搭桥术中平均转流量、平均动脉压和鼻咽温变化。结果冠脉搭桥术前时,两组患者大脑中动脉血流差异无统计学意义(P>0.05)。在麻醉后和体外循环时,两组患者脑血流量(CBF)较术前明显减低(P<0.05),体外循环时较麻醉后无明显变化(P>0.05);手术后脑血流流速CBF较麻醉后和体外循环显著回升(P<0.05);但是A组患者在麻醉后、体外循环时和手术后CBF均显著低于B组(P<0.05)。体外循环时A组患者平均体表面积转机流量和平均动脉压显著高于B组(P<0.05),而鼻咽温变化不明显(P>0.05)。结论在体外循环下行冠状动脉搭桥术中,患者大脑中动脉血流在麻醉后显著减低,体外循环时较麻醉后无明显变化,手术后脑血流流速上升。而颈动脉狭窄≥50%患者在麻醉后及手术后较狭窄<50%患者脑血流显著减低。Objective To explore the changes of cerebral blood flow in coronary artery bypass grafting and the effect of carotid stenosis on cerebral blood flow. Methods Total 51 patients who underwent coronary artery bypass graft（CABG） on cardio-pulmonary bypass（CPB） were studied. Patients were divided into two groups according to the degree of the carotid artery stenosis, carotid artery stenosis ≥50% patients as A group, and 50% patients as B group. Media cerebral artery（MCA） peak velocity and diastolic velocity were recorded during the operation and the mean velocity of both groups were calculated pre-operatively, under general anesthesia, and during CPB with pump off. The blood flow of CPB, mean blood pressure and the nasal temperature were investigated. Results Before coronary artery bypass surgery, there was no significant difference in MCA blood flow between the two groups（P〈0.05）; cerebral blood flow（CBF） was significantly lower（P〈0.05）in the two groups after anesthesia and cardiopulmonary bypass; there was no significant change after the cardiopulmonary bypass（P〈0.05）. The flow velocity of cerebral blood flow after operation was significantly increased（MCA） after anesthesia and cardiopulmonary bypass（P〈0.05）. However, the CBF of patients in A group were significantly lower than that in B group after anesthesia, cardiopulmonary bypass and surgery（P〈0.05）. The average surface area of A group was significantly higher than that of B group（P〈0.05）, while the nasopharyngeal temperature change was not obvious（P〈0.05）. Conclusion In patients with coronary artery bypass grafting, the cerebral blood flow was significantly decreased after anesthesia, and there were no significant changes after cardiopulmonary bypass, but was increased after surgery. The cerebral blood flow of patients with carotid artery stenosis≥50% was decreased significantly when compared with carotid artery stenosis 50% patients after anesthesia and operation.

关 键 词：冠脉搭桥 体外循环 脑血流 经颅超声多普勒 

分 类 号：R541.4[医药卫生—心血管疾病]