经胸多普勒超声心动图观察冠状动脉旁路移植术围术期左乳内动脉-左前降支桥血管的血流变化  

Perioperative Ultrasonic Observation on Variation of Blood Flow of LIMA to Anterior Descending Artery in Patients Undergoing Coronary Artery Bypass Grafting

作　　者：赵舟[1] 高俊雪[1] 秦俊超 刘晶[1] 刘刚[1] 陈生龙[1] 陈彧[1] ZHAO Zhou, GAO Jun-xue, QIN Jun-chao, LIU Jing, LIU Gang, CHEN Sheng-long, CHEN Yu(Department of Cardiac Surgery, Heart Center, People＇s Hospital of Peking University, Beijing （100044）, China)

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》2018年第7期690-693,共4页Chinese Circulation Journal

摘　　要：目的:分析经胸多普勒超声心动图观察左乳内动脉(LIMA)-左前降支(LAD)的吻合的冠状动脉(冠脉)旁路移植术(CABG)围术期LIMA桥的血流变化。方法:选取2015-2016年间于我院心外科接受CABG的患者94例,男性75例(79.8%),平均年龄(63.4±9.6)岁;受试者均术前行经胸多普勒超声检查,均接受了LIMA-LAD的吻合。术中使用瞬时血流测量仪(TTFM)测量LIMA桥的血流量和搏动指数(PI),术后1周出院前再次行经胸多普勒超声检查LIMA桥。结果:LIMA桥的血流量及搏动指数,术后1周[(39.81±23.87)ml/min、(35.86±27.72)ml/min;1.54±0.64、3.05±1.54]均较术前[(27.08±16.48)ml/min、(35.87±39.46)ml/min;4.24±1.50、4.01±1.80]和术中[(28.23±21.00)ml/min;2.78±1.50]均显著增加(P均<0.001)。术前双侧乳内动脉直径差异无统计学意义(P=0.425),术后LIMA的直径较右乳内动脉显著增大[(2.26±0.21)mm vs(2.20±0.25)mm,P=0.043)。结论:术后经胸多普勒超声心动图可作为术后早期评估桥血管血流通畅性的重要手段之一,相较于术前和术中,术后1周LIMA桥血流较前明显增加。Objectives： To analyze and compare ultrasonic blood flow of left internal mammary artery（LIMA）as graft in pre-, intra-and post-operation and observe the changes of blood flow and diameter of LIMA throughout the perioperative period in patients undergoing coronary artery bypass grafting.Methods： A total of 94 patients（75 male, mean age： 63.4±9.6 years）, who underwent CABG including LIMA-to-LAD anastomoses in our hospital between 2015 and 2016, were included in this study. Transthoracic ultrasound examination was performed before CABG. The blood flow and the value of PI（pulsation index） of LIMA to left anterior descending were measured and recorded by intraoperative TTFM. Transthoracic ultrasound examination was repeated at 1 week after CABG before discharge to evaluate the LIMA-to-LAD anastomoses. One-year of following up, coronary artery CT or coronary angiography examination were accomplished. Results： Blood flow and pulsation index of LIMA to LAD were significantly improved at one week post CABG（[39.81±23.87]ml/min, [35.86±27.72]ml/min;1.54±0.64, 3.05±1.54） than in preoperative（[27.08±16.48]ml/min、[35.87±39.46]ml/min;4.24±1.50、4.01±1.80） and intraoperative（[28.23±21.00]ml/min;2.78±1.50） period（P 0.001）. The diameter of preoperative LIMA and RIMA was similar（P=0.425）, the postoperative diameter of LIMA was significantly larger than that of RIMA（[ 2.26± 0.21]mm vs [2.20± 0.25]mm,P=0.043）.Conclusions： Transthoracic ultrasound examination of LIMA to LAD blood flow and pulsation index can be used as early postoperative evaluation for graft flow and patency. At one week post CABG, blood flow of LIMA-LAD increased significantly compared with the preoperative and intraoperative level.

关 键 词：超声心动描记术 冠状动脉旁路移植术 乳内动脉 瞬时血流测定 

分 类 号：R541[医药卫生—心血管疾病]