加强冠状动脉旁路移植术的质量控制  

Strengthening the quality control of coronary artery bypass grafting

作　　者：顾松[1] 苏丕雄[1] Gu Song;Su Pixiong(Department of Cardiac Surgery,Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院心脏外科,100020

出　　处：《中华外科杂志》2020年第5期345-349,共5页Chinese Journal of Surgery

摘　　要：冠状动脉旁路移植术的质量控制是保证旁路血管通畅和患者获得良好远期效果的重要前提。其中术前靶血管的评估是基础,手术方式的选择是手段,旁路血管的高质量获取是保障,吻合方式和吻合口质量是核心。术中瞬时流量测定作为目前最常用的质量控制工具,可以有效地检测出由于吻合口狭窄导致的旁路血管失功能,指导旁路血管翻修。但是部分研究结果显示其阳性预测值较低,且与旁路血管远期通畅率的关系证据不足。术中瞬时流量测定联合高分辨率心外膜超声可提高冠状动脉旁路移植术的手术质量、安全性和有效性,可作为术中质量控制的重要方法。术中一旦发现旁路血管及吻合口形态异常、血流量不满意,需要立即调整或重新吻合。冠状动脉旁路移植术质量控制需要心脏外科医师综合判断,采取个体化措施,以保障患者围手术期安全及远期效果。The quality control of coronary artery bypass grafting(CABG)is an important prerequisite to the graft patency and the long-term outcomes.The evaluation of target vessel is the basis,the choice of surgical types is the means,the high-quality acquisition of graft harvesting is the guarantee,and the anastomotic method and quality is the core.As the most commonly used quality control tool,intraoperative transit time flow measurement can effectively detect the coronary graft failure caused by anastomotic stenosis and guide to repair of the graft.However,some studies showed that the positive predictive value is low,and the evidence is insufficient for the relationship with the long-term patency rate of grafts.Intraoperative instantaneous flow measurement combined with high-resolution epicardial ultrasound can improve the quality,safety and effectiveness of CABG,which should be an important recommendation for CABG quality control.Once the shape of the grafts and anastomotic ports is abnormal and the blood flow is not satisfied,it needs to adjust or re-anastomose immediately.The quality control of CABG requires comprehensive judgment and individualized measures to ensure the safety and long-term outcome of patients.

关 键 词：冠状动脉疾病 冠状动脉分流术 质量控制 超声多普勒流量测定 

分 类 号：R65[医药卫生—外科学]