体外循环下左乳内动脉、桡动脉“T型”吻合行左心全动脉化的临床分析  

Clinical Analysis of Left Ventrical Total Artery Revascularization with “T”-type Anastomosis of Left Internal Mammary Artery and Radial Artery on Pump

作　　者：李金东[1] 武艳红[1] 董铭峰[1] 王建堂[1] 柴守栋[1] 唐培哲[1] 柳涛[1] 栗振坤[1] 夏峰[1] 马胜军[1] 

机构地区：[1]山东省聊城市人民医院心外科,山东聊城252000

出　　处：《中国胸心血管外科临床杂志》2016年第11期1082-1085,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的 研究体外循环下左乳内动脉、桡动脉“T型”吻合行左心室全动脉化的冠状动脉旁路移植术的临床效果。方法 回顾性分析2013年12月至2015年12月我院心外科40例行体外循环下左乳内动脉、桡动脉“T型”吻合行左心室全动脉化的冠状动脉旁路移植术患者的临床资料,男27例、女13例,年龄46~70（55.0±10.2）岁。采用冠状动脉血流测量仪分别测量左乳内动脉原位状态及术后左乳内动脉主干血流量情况,分别检测患者术前及术后24 h血清中血肌钙蛋白I（c Tn I）的浓度,观察患者术后并发症发生情况。结果 术后左乳内动脉主干血量明显高于术前左乳内动脉原位状态血量,差异有统计学意义（P〈0.05）。术后24 h患者血清中血肌钙蛋白I的浓度略高于术前,但差异无统计学意义（P〉0.05）。全组患者无死亡,术后早期发生快速心房颤动2例,术后低心排血量1例,经治疗后全部好转,无围术期心肌梗塞、无神经系统并发症,桡动脉切口无并发症。随访6个月至1年,无心源性并发症,无心绞痛复发。25例患者术后1年时随访行冠状动脉CTA检查桥血管通畅率,动脉桥通畅率96.0%,右冠状动脉静脉桥血管通畅率为90.4%。结论 体外循环下左乳内动脉、桡动脉T型吻合行左心室全动脉化的冠状动脉旁路移植术有良好的临床效果。Objective To asses the clinical result of left ventrical total artery revascularization with ＂T＂ -type anastomosis of left internal mammary artery （LIMA） and radial artery on pump. Methods We retrospectively analyzed the clinical data of 40 patients who underwent left ventrical total artery revascularization with ＂T＂ -type anasmtomosis of LIMA and radial artery on pump in our hospital between December 2013 and December 2015 year. There were 27 males and 13 females at age of 46-70 （55.0±10.2） years. The radial artery anastomosis was made sequentially to the left obtuse artery, intermediate artery, diagonal artery and left anterior descending artery. LIMA anastomosis was made to the radial artery closed to the left anterior descending artery. Saphenous vein （SV） anastomosis was made to right coronary artery. LIMA blood flow was measured with coronary artery Butterfly Flowmeter when LIMA was in suit and after operation. cTnI was measured at different time points. Complications after operation were studied. Results The blood flow of LIMA after operation was significantly different from that in suit （P〈0.05）. The plasm cTnI postoperation was higher than that preoperation, but the difference was not significant. All the patients were survival. Atrial fibrillation occurred in 2 patients and low cardiac output occurred in 1 patient after operation, but they recovered quickly after proper treatment. There was no myocardial infraction or hand ischemia during postoperation. There was no recurrence of mycardial infarction within 6 months to 1 year follow-up. Graft patency was assessed using 128-slice CT coronary angiography in 25 patients. Cumulative graft patency rates were 96.0% in LIMA and 90.4% in SV grafts. Conclusion Left ventrical total artery revascularization with ＂T＂ -type anasmtomosis of LIMA and radial artery on pump is safe and effective.

关 键 词：冠状动脉旁路移植 桡动脉 全动脉化 体外循环 

分 类 号：R654.2[医药卫生—外科学]