使用双侧乳内动脉行冠状动脉旁路移植术早期结果分析  

Early outcome of coronary artery bypass graft surgery using bilateral internal mammary artery

作　　者：畅怡[1] 王小啟[1] 郑哲[1] 樊红光[1] 李浩杰[1] 侯剑峰[1] 高歌[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院成人外科中心,北京100037

出　　处：《中国胸心血管外科临床杂志》2017年第3期206-210,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的分析使用双侧乳内动脉(BIMA)行冠状动脉旁路移植术(CABG)后的早期临床及CT结果和桥血管流量,探讨手术的安全性、有效性及桥流量特点。方法回顾性分析2015年12月至2016年7月我院使用双侧乳内动脉行CABG 52例患者的临床资料,其中男46例、女6例,平均年龄(56.6±6.8)岁。所有患者均在体外循环下进行,带蒂方式获取双侧乳内动脉,根据靶血管情况设计搭桥路径。完成吻合后,取平均动脉压70 mm Hg时使用Veri Q系统行桥血管即时流量测定。出院前行冠状动脉CT检查,评估桥血管通畅情况。评价围术期结果、早期CT结果及桥流量。结果无手术死亡。平均手术时间(4.7±0.6)h,平均体外循环时间(114.8±20.6)min,平均主动脉阻断时间(82.8±17.6)min,平均呼吸机使用时间(17.6±10.5)h,平均ICU停留时间(2.7±1.8)d。平均远端吻合口数(4.6±0.8)个。1例患者出现胸骨松动、伤口愈合不良,行清创缝合后治愈,其余患者无手术并发症,均康复出院。左乳内动脉桥平均流量(28.1±11.4)ml/min,平均搏动指数2.2±0.6;右乳内动脉桥平均流量(27.3±12.0)ml/min,平均搏动指数2.4±0.8;大隐静脉桥平均流量(41.5±21.5)ml/min,平均搏动指数2.2±0.7。左乳内动脉桥与右乳内动脉桥平均流量差异无统计学意义(P=0.978)。左乳内动脉桥、右乳内动脉桥平均流量分别与大隐静脉桥平均流量比较,差异有统计学意义(P=0.000)。出院前CT显示无桥血管狭窄出现;7支静脉桥、5支动脉桥吻合口远端显影浅淡,但仍通畅;2支静脉桥未显影,提示桥血管闭塞。结论使用BIMA行CABG,手术安全性高、并发症少;双侧乳内动脉桥流量相当,动脉桥早期无狭窄闭塞,是稳定理想的冠状动脉旁路移植物。Objective To investigate the safety, efficacy of the surgery and the characteristics of the blood flow after coronary artery bypass graft （CABG） surgery using bilateral internal mammary artery （BIMA） to analyze the early operative results, CT results and the graft flow. Methods From December 2015 to July 2016, 52 patients （46 males, 6 females） with an average age of 56.6±6.8 years, underwent CABG using bilateral internal mammary artery. All the operations were carried out under extracorporeal circulation, both internal mammary arteries were obtained with pedicle and the bypass path was designed according to the target vessels. After the anastomosis was completed, the graft flow was measured using Veri Q system. The CT angiography of coronary artery was completed before discharge. Perioperative outcomes, early CT outcomes, and blood flow of grafts were analysed. Results There was no operative mortality. The average operation time was 4.7±0.6 hours, average cardiopulmonary bypass time was 114.8±20.6 minutes, average cross-clamping time was 82.8±17.6 minutes, average mechanical ventilation time was 17.6±10.5 hours and average ICU stay was 2.7±1.8 days. The mean number of distal anastomosis was 4.6±0.8. One patient suffered sternal complication and poor wound healing and then receieved debridement as well as suturing. Other patients discharged without surgical complications. The average flow of left internal mammary artery （LIMA） graft was 28.1±11.4 ml/min with a mean pulsatility index （PI） of 2.2±0.6. The average flow of right internal mammary artery （RIMA） was 27.3±12.0 ml/min with a mean PI of 2.4± 0.8. The mean flow of great saphenous vein was 41.5±21.5 ml/min with a mean PI of 2.2±0.7. There was no significant difference in the mean flow between LIMA and RIMA （P=0.978）. The mean flow of the great saphenous vein was significantly higher than that of RIMA and LIMA （P=0.000）. CT angiography showed no stenosis. Distal anastomosis of 7 vein grafts and 5 artery grafts was d

关 键 词：冠状动脉旁路移植术 乳内动脉 搏动指数 

分 类 号：R654.2[医药卫生—外科学]