乳内动脉-大隐静脉Y型复合桥血管的术中即时血流量测定及中期通畅率随访  

Study on the intraoperative blood flow parameters and mid-term follow-up of composite left internal thoracic artery-saphenous vein T-grafts

作　　者：安康[1] 梅举[1] 汤敏[1] 刘浩[1] 朱家全[1] 尹航[1] 

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,上海市200092

出　　处：《中国心血管病研究》2017年第5期413-417,I0001,共6页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨乳内动脉（LIMA）-大隐静脉（SV）Y型复合桥血管的术中即时血流量以及术后中期通畅率.方法 选择2013年1月到2015年12月24例在上海新华医院心胸外科接受非停跳冠状动脉旁路移植术（OPCAB）的患者作为研究对象,均在术中应用Y型复合桥血管（LIMA-SV）.术中使用TrFM进行桥血管血流测定.出院后1年复查冠状动脉血管造影（CTA）评估桥血管通畅率.结果 所有患者均接受OPCAB,平均吻合移植血管（2.5±0.5）支,术中无中转体外循环.住院期间无死亡患者.SV单根组和SV序贯组之间Y型复合桥血管主干（近端LIMA）的平均血流未见统计学差异（P＞0.05）,远端LIMA（LIMA-LAD）平均血流也未见统计学差异（P＞0.05）.SV序贯组的SV主干的平均血流高于SV单根组[（24.6±9.8）ml/min比（19.2±5.7）ml/min],但未见统计学差异（P=-0.056）.两组之间不同靶血管的搏动指数（PI值）未见统计学差异.术后1年冠状动脉CTA显示,所有桥血管的总通畅率为96.7％（59/61）,其中LIMA桥的通畅率为100％（24/24）,SV桥的通畅率为94.6％（35/37）.结论 LIMA-SV Y型复合桥血管能够为SV和远端LIMA提供足够的血流,中期通畅率良好,对不能获取右乳内动脉或桡动脉且合并升主动脉钙化的患者是一种良好的替代方案.Objective We aimed at assessing the intraoperative flow parameters of the composite left internal mammary artery（LIMA）-saphenous vein（SV） Y-graft and evaluating the graft patency 1 year after the procedure.Methods From January 2013 to December 2015,24 patients with severe atherosclerotic ascending aorta underwent off-pump coronary artery bypass graft （OPCAB） using composite LIMA-SV Y-grafts.Transit time flow measurement（TTFM） was routinely performed during the operation.Graft patency was evaluated by using computed tomography angiography （CTA） 1 year after discharge.Results All patients underwent complete revascularization.The average number of grafts was 2.5±0.5.There was no conversion to on-pump or in-hospital death.The mean flow of main stem（proximal LIMA） was similar between sequential saphenous vein grafting（SVG） group and individual SVG group[（53.3±16.1）ml/min vs （48.8±12.6）ml/min].No differences in the mean flow of LIMA branch （LIMA-LAD）were found between two groups.The mean flow of SV main branch was higher in sequential SVG group than in individual SVG group [（24.6±9.8）ml/min vs （19.2±5.7）ml/min,P=0.056].PI of all anastomoses did not differ between two groups.Overall graft patency 1 year after procedure was 96.7%（59/61） and was 100% （24/24） for the LIMA and 94.6%（35/37） for SVG.Conclusion Composite LIMA-SV Y-graft allows adequate reperfusion of both SV and distal LIMA.The mid-term patency rate is satisfactory.For patients who have severe atherosclerosis of ascending aorta and whose right internal mammary artery or radial artery are unavailable,composite LIMA-SV Y-graft is an alternative option.

关 键 词：非停跳冠状动脉旁路移植术 即时血流量测定 Y型复合桥血管 通畅率 大隐静脉序贯桥 

分 类 号：R654.2[医药卫生—外科学]