心肌灌注变化对CABG后桥血管通畅性的预测价值  

Myocardial perfusion predicts the patency of grafts after coronary artery bypass grafting

作　　者：史泽鹏 潘晓芳[2] 王文君 高洋[3] 高峰[3] 石磊[3] 刘巍 张博[2] 孙飞一[2] 庄熙晶[3] 何学志[3] SHI Zepeng;PAN Xiaofang;WANG Wenjun;GAO Yang;GAO Feng;SHI Lei;LIU Wei;ZHANG Bo;SUN Feiyi;ZHUANG Xijing;HE Xuezhi(Graduate School,Dalian Medical University,Dalian,Liaoning,116044,China;Department of Ultrasound Imaging,Dalian Municipal Central Hospital;Department of Cardiovascular,Dalian Municipal Central Hospital)

机构地区：[1]大连医科大学研究生院,辽宁大连116044 [2]大连市中心医院超声影像科 [3]大连市中心医院心脏大血管外科

出　　处：《临床心血管病杂志》2020年第11期1039-1044,共6页Journal of Clinical Cardiology

摘　　要：目的:评估冠状动脉旁路移植(CABG)术后早期及术后1年时心肌灌注变化对桥血管通畅情况的预测价值。方法:选取2018年1月—2019年6月由同一术者完成CABG的81例患者。术后2周行心肌灌注超声造影(MCE)检查评估心肌灌注微循环血供情况。术后随访1年,并于术后1年时复查冠状动脉(冠脉)CTA及心脏超声。结果:术后1年桥血管通畅组患者73例(A组),桥血管闭塞组患者8例(B组)。A组术后早期、术后1年时各冠脉区域及心肌灌注总MCE分值改善明显(P<0.05),术后早期、术后1年心脏超声示左心系统结构及左室射血分数(LVEF)值存在明显统计学差异(P<0.05)。B组术后早期、术后1年时仅左回旋支(LCX)支供血区域MCE分值改善明显(t=2.111,P<0.05),余冠脉区域改善未见明显差异(P>0.05)。术后早期及术后1年心脏超声结果示左心室舒张期末直径明显扩张(t=1.983,P<0.05),而左心房收缩末期直径及LVEF改善均不明显(P>0.05)。左胸廓内动脉-左前降支(LIMA-LAD)、主动脉-大隐静脉-右冠脉(AO-SVG-RCA)桥血管通畅程度与对应区域灌注改善情况的一致性较高,且差异具有统计学意义(P<0.05)。结论:CABG患者术后心肌灌注改善情况可间接反映术后桥血管通畅性。术后完善心肌灌注评估,对于预测患者术后桥血管通畅情况具有重要意义。Objective: To evaluate the predictive value of myocardial perfusion changes in early and 1 year after coronary artery bypass graft(CABG). Method: The 81 CABG patients completed by the same surgeon from January 2018 to June 2019 were selected. Myocardial perfusion contrast-enhanced ultrasonography(MCE) was performed 2 weeks after the operation to evaluate the microcirculation blood supply of myocardial perfusion. The patients were followed up for 1 year, and the coronary CTA and echocardiography were reviewed 1 year after the operation. Result: One year after the operation, there were 73 patients in the bypass graft patency group(group A), and 8 patients in the bypass graft occlusion group(group B). In group A, the MCE scores of each coronary artery area and myocardial perfusion improved significantly at the early postoperative period and 1 year after surgery(P<0.05). There were statistically significant differences in left cardiac system structure and EF value between the early postoperative period and 1 year after the operation(P<0.05). In group B, MCE score in LCX branch was significantly improved in the early postoperative period and 1 year after surgery(t=2.111;P<0.05), while no significant difference was found in other coronary artery regions(P>0.05). Echocardiographic results at the early stage and 1 year after surgery showed significant expansion of left ventricular end-diastolic diameter(t=1.983;P<0.05), while no significant improvement of left atrial end-systolic diameter or LVEF(P>0.05). The patency degree of LIMA-LAD and Ao-SVG-RCA bypass graft was consistent with the improvement of perfusion in corresponding regions, and the difference was statistically significant(P<0.05). Conclusion: Improvement of postoperative myocardial perfusion in CABG patients can indirectly reflect the patency of postoperative bypass graft. The improvement of postoperative myocardial perfusion assessment is of great significance for predicting the patency of postoperative bypass graft in patients.

关 键 词：心肌灌注 冠状动脉搭桥术 桥血管 通畅性 

分 类 号：R541.4[医药卫生—心血管疾病]