冠状动脉旁路移植术后后降支单根和序贯旁路血管瞬时流量比较  

A comparative study of individual and sequential saphenous vein grafts instantaneous flow in posterior descending artery

作　　者：宋伟[1] 李京倖[1] 顾承雄[1] 于洋[1] 黄信生[1] 

机构地区：[1]首都医科大学附属北京安贞医院心外科,100029

出　　处：《中华胸心血管外科杂志》2018年第1期43-45,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 使用瞬时流量测定同一患者后降支单根旁路和序贯旁路血管平均血流量（MF）和博动指数（PI）,进行对比研究,为临床选择手术方法提供参考.方法 140例冠状动脉硬化性心脏病三支病变患者行不停跳冠状动脉旁路移植术,前降支使用左乳内动脉血管（单支桥）,其他病变冠状动脉采用大隐静脉序贯旁路移植（序贯桥）方法,即大隐静脉-对角支（侧-侧）-钝缘支（侧-侧）-后降支（端-侧）.使用哈巴狗于序贯桥吻合口近大隐静脉侧临时夹闭两个侧侧吻合口,模拟后降支为单支血管,放开哈巴狗,恢复序贯旁路.测量两种情形下后降支静脉移植血管MF和PI.术后6个月行门诊冠状动脉CTA检查,了解旁路血管情况.结果 后降支单支桥与序贯桥比较,MF：（22.5±13.1）ml/min对（22.2±12.9）ml/min,差异无统计学意义（P〉0.05）;PI：2.43±0.94对2.38±0.88,差异无统计学意义（P〉0.05）.结论 后降支单支旁路与序贯旁路血管的血流动力学效果一致.术者可根据自身习惯、外科技术水平,结合患者病情,合理选择手术方法. Objective To evaluate the mean blood flow（MF） and pulsatility index（PI） of individual and sequential sa-phenous vein grafts in posterior descending artery（PDA） in the same patient undergone off-pump coronary artery bypass grafting （OPCABG）.Methods 140 patients with coronary artery disease were studied.Sequential surgical technique using single large saphenous vein was used in grafts of diagnostic artery（DIAG）（side-side）, obtuse marginal artery（OM）（side-side）, and PDA（ end-side） .Bulldog clamps were used to temporarily arrest the anastomoses of DIAG and OM near the large saphenous vein .Thus the sequential graft became to the single graft , the MF and PI of PDA were recorded in the simulating single graft by the transit-time flow measurement（TTFM）, after that, bulldog clamps were removed and the MF and PI of PDA were recorded again in the real sequential graft.The data were compared.Six months later after surgery, coronary CTA were done in all pa-tients in clinic.Results The MF of single graft and sequential graft was（22.5 ±13.1）ml/min and（22.2 ±12.9）ml/min（P〉0.05）.The PI of single graft and sequential graft was 2.43 ±0.94 and 2.38 ±0.88（P〉0.05）.The patency of all grafts is good in all patients after 6 months follows-up.Conclusion There ars no hemodynamic differences between individual and sequential grafts in PDA.It is reasonable that the short-term surgical result is the same in individual and sequential grafts in PDA.

关 键 词：冠状动脉硬化 冠状动脉旁路移植术 非体外循环 瞬时流量 对比研究 

分 类 号：R654.2[医药卫生—外科学]