原位双乳内动脉冠状动脉旁路移植术围手术期移植血管血流变化  

Perioperative study of blood flow of in-situ BIMA in coronary artery bypass grafting

作　　者：赵舟[1] 张犁雪[1] 张国栋 张显贵 王璇 高俊雪[1] 范桄溥[1] 廉波[1] 刘晶[1] 刘刚[1] 陈生龙[1] 陈彧[1] Zhao Zhou;Zhang Lixue;Zhang Guodong;Zhang Xiangui;Wang Xuan;Gao Junxue;Fan Guangpu;Lian Bo;Liu Jing;Liu Gang;Chen Shenglong;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,100044

出　　处：《中华胸心血管外科杂志》2020年第3期175-179,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的使用原位双侧乳内动脉行冠状动脉旁路移植术(CABG),观察围手术期动脉旁路移植血管血流参数变化趋势,对比两侧乳内动脉旁路移植血管血流参数,初步探讨双侧旁路移植血管流量特性。方法选取2016年8月至2019年1月期间在我院心外科实施原位双乳内动脉冠状动脉旁路移植术患者57例,其中男50例,女7例;年龄29~77岁,平均(57.8±10.1)岁。患者术前均行经胸乳内动脉超声检查,术中使用TTFM测量并记录旁路移植血管血流量和搏动指数等相关参数,并行统计学数据分析。结果全组手术无死亡。术前左、右两侧乳内动脉的平均直径和搏动指数差异均无统计学意义(P>0.05),但右侧乳内动脉血流量更高(P=0.026)。术中左、右两侧动脉旁路移植血管的血流量和搏动指数差异均无统计学意义(P>0.05),但左侧移植血管舒张期血供比例更高(P=0.022)与术前乳内动脉自身流量相比,术中左、右两侧移植血管血流量均较术前明显提升(P<0.001),搏动指数也较术前更优(P<0.001)。结论实施双侧乳内动脉CABG手术的患者,与术前乳内动脉自身血流相比,术中左、右两侧动脉旁路移植血管血流量均有明显改善,搏动指数更优。术中靶血管位点存在不同,但两侧旁路移植血管的血流量和搏动指数差异均无统计学意义。Objective To observate the changing trend of flow of in-situ bilateral internal mammary artery as grafts during perioperative period in patients undergoing coronary artery bypass grafting(CABG),and to compare the parameters of flow between LIMA and RIMA.Methods A total of 57 patients,50 males and 7 femails,mean aged(57.8±10.1)years,underwent bilateral IMA CABG in our hospital from August 2016 to January 2019.Transthoracic ultrasound of IMA examination was performed before CABG.The blood flow,the PI(pulsation index)and other parameters were measured and recorded by intraoperative TTFM.Results There was no significant difference of the average diameter and PI between LIMA and RIMA,but the preoperative flow of RIMA is higher(P=0.026)in our study.There was no significant difference of the average flow and PI between LIMA and RIMA recorded by TTFM(P>0.05),but the higher diastolic flow(DF)in LIMA grafts(P=0.022)compared with RIMA grafts may be associated with the different target sites(P<0.05).Compared with the preoperative flow and PI of IMA,the intraoperative flow and PI of both LIMA and RIMA grafts were better(P<0.001).Conclusion Compared with the preoperative flow of IMA,both flow of LIMA and RIMA are better.In spite of the targets exist difference,there are no significant difference of the average flow and PI between LIMA graft and RIMA graft recorded by TTFM.

关 键 词：乳内动脉 冠状动脉旁路移植术 瞬时血流测定 经胸乳内动脉超声 

分 类 号：R65[医药卫生—外科学]