左胸小切口与胸骨正中切口非体外冠状动脉旁路移植术中左乳内动脉桥血流对比分析  

Comparative Study of Internal Mammary Artery Flow Between Left Minimal Incision and Median Sternotomy in Off-pump Coronary Artery Bypass Grafting

作　　者：韩增强[1] 陈彧[1] 凌云鹏[1] 陈生龙[1] 刘刚[1] 杨威[1] 范桄溥[1] 孙文强[1] 

机构地区：[1]北京大学人民医院心脏中心心脏外科,北京市100044

出　　处：《中国循环杂志》2016年第10期981-983,共3页Chinese Circulation Journal

摘　　要：目的:通过超声瞬间血流仪在术中评估左胸小切口冠状动脉旁路移植术(MIDCAB)和胸骨正中切口非体外循环下冠状动脉旁路移植术(OPCAB)患者左乳内动脉(LIMA)桥的血流情况。方法:2013-01至2015-07期间300例患者接受OPCAB,LIMA全部与左前降支(LAD)吻合。70例患者采用MIDCAB,为MIDCAB组,同期有230例患者采用传统正中开胸OPCAB,为传统OPCAB组。术中应用即时血流测量技术对旁路血管进行血流测量。对比分析两组术前、术后的各项指标及LIMA桥血管的平均流量、搏动指数、舒张期充盈百分比和血流波形。结果:传统OPCAB组和MIDCAB组的手术输血量分别为(3.00±5.42)U和(1.06±2.17)U;术后心肌肌钙蛋白I(c Tn I)峰值分别是(2.84±9.93)ng/ml和(0.69±1.74)ng/ml;呼吸机使用时间分别是(27.90±66.90)h和(14.20±20.80)h;重症监护病房停留时间分别是(64.10±89.60)h和(35.20±39.20)h,两组差异均有统计学意义(P<0.05)。两组的LIMA至LAD的桥血管平均流量[(29.45±18.19)ml/min vs(29.04±15.85)ml/min]、搏动指数(2.68±1.19 vs 2.44±0.84)、舒张期充盈百分比[(71.47±11.12)%vs(70.25±11.30)%]的差异均无统计学意义(P均>0.05)。结论:进行LIMA至LAD搭桥,采用MIDCAB可取得与传统OPCABG同样的效果,术后早期吻合口质量可靠。Objective：To compare the blood flow of left internal mammary artery（LIMA） graft vessel between minimally invasive direct coronary artery bypass（MIDCAB） and traditional median sternotomyin off-pump coronary artery bypass（Traditional OPCAB） by transit-time flow meter（TTFM）.Methods：We retrospectively studied 300 patients who received OPCAB in our hospital from 2013-01 to 2015-07,all patients had LIMA to left anterior descending coronary artery（LAD） anastomosis.The patients were divided into 2 groups：MIDCAB group,n=70 and Traditional OPCAB group,n=230.Intra-operative blood flow in graft vessel was measured by transit-time flow meter.Pre-and post-operative indexes and the mean flow（MF）,pulsatile index（PI）,diastolic fraction（DF） of LIMA graft were compared between 2 groups.Results：The following indexes in Traditional OPCAB group and MIDCAB group were as below：intra-operative transfusion was（3.00±5.42） U vs（1.06±2.17） U,post-operative peak value of c Tn I was（2.84±9.93） ng/ml vs（0.69±1.74） ng/ml,mechanical ventilation time was（27.9±66.9） h vs（14.2±20.8） h and ICU stay time was（64.1±89.6） h vs（35.2±39.2） h,all P〈0.05;while for the graft from LIMA to LAD,MF was（29.45±18.19） ml/min vs（29.04±15.85） ml/min,PI was（2.68±1.19） vs（2.44±0.84） and DF was（71.47±11.12） % vs（70.25±11.30） %,all P〉0.05.Conclusion：With LIMA to LAD graft,MIDCAB may achieve the same effect as traditional OPCAB,the early post-operative anastomosis has been reliable.

关 键 词：冠状动脉旁路移植术 非体外循环 乳内动脉 瞬时血流测定技术 

分 类 号：R54[医药卫生—心血管疾病]