心外膜超声结合即时血流测量仪在OPCABG术中的应用  

Application of epicardial ultrasound combined with TTFM in OPCAB

作　　者：王圣[1] 程兆云[1] 赵子牛[1] 周胜凯[1] 夏东升[1] 李建强[1] 李广辉 

机构地区：[1]河南省人民医院心血管外科,河南省郑州市450003

出　　处：《中国心血管病研究》2017年第10期916-919,I0001,共5页Chinese Journal of Cardiovascular Research

基　　金：国家临床重点专科建设项目（2011）;河南省科技发展计划项目（项目编号：132102310190）

摘　　要：目的分析评估心外膜超声结合即时血流测量仪（TTFM）在非体外循环冠状动脉搭桥（OPCABG）术中的应用效果及体会。方法回顾分析2016年1～12月共有85例行非体外循环冠状动脉搭桥术的患者术中应用了心外膜超声及TTFM，其中男性46例、女性39例，年龄44-82岁，平均年龄65．6岁。搭桥采用全动脉化方案（左侧乳内动脉＋双侧桡动脉）9例、全静脉化方案（Y型桥）2例，其余均为左侧乳内动脉＋大隐静脉常规方案，静脉桥均采用先吻合主动脉近端的方式，且均为序贯桥。术后1、3、6个月进行随访。结果1例左乳内动脉与前降支吻合后，检测桥血管发现流量低及血流阻力高，遂拆除原吻合口重新做桥血管吻合，再次检测流量及血流阻力满意。其余手术均顺利完成，术毕测桥血管流量及血流阻力均达到临床标准；术中血流动力学稳定，无围术期急性心梗及死亡病例，术后无脑血管事件发生，无主动脉损伤等主动脉不良事件，术后短期随访期间无心绞痛复发病例。结论冠状动脉搭桥术中应用心外膜超声，可以有效避开粥样斑块，将吻合口做在内膜相对光滑的靶血管上，有利于保证吻合口的近、远期通畅；术毕应用TTFM，可以即时检测桥血管流量及血流阻力，保证了手术的安全性，值得在临床上广泛推广应用。Objective To evaluate the effect and experience of epicardial ultrasound combined with transit time flow measurement（TTFM ） in off-pump coronary artery bypass （OPCABG）. Methods Retrospectively analyzed 85 cases of patients received OPCAB and used epieardial ultrasound combined with TTFM from January to December in 2016. The patients included 46 cases of men and 39 cases of women, the age from 44 to 82 and the average age was 65.6. Nine cases adopted complete arterial revascularization （LIMA ＋BRA）, two cases adopted complete venous revaseularization （＂Y＂ bypass-conduits）, the rest cases were LIMA＋SVG. The vein-bypass-conduits were anatomized proximal aorta preferentially. They were all sequential bypass conduits. The follow-up were carried out in postoperation of 1, 3, 6 months. Results One case showed the low flow and high PI after LIMA were anatomized to LAD. So the anastomosis were redone, then the flow and PI were satisfied. The results in rest cases were all satisfied and met the clinical standards. The hemodynamics was stable in the operation and there were not perioperative myocardial infarction and death in all cases. Also there were no MACE and aortic injury cases. There were no recurrence of angina in postoperative short-term. Conclusion Using of the epicardial ultrasound in CABG can avoid anastomosing to the atheromatous plaque and insure the short-time and long-term patency of the bypass-conduits. The epicardial ultrasound combined with TTFM can measure the flow and PI of the conduits after finished the operation, and then ensure the security of operation, it is worthy to be widely used in clinical practice.

关 键 词：心外膜超声 即时血流测量仪 非体外循环冠状动脉搭桥术 

分 类 号：R654.2[医药卫生—外科学]