冠状动脉吻合口探查疏通术在冠状动脉旁路移植术中的应用研究  

The implication of anastomotic port exploration and dredging in coronary artery bypass grafting

作　　者：张帆[1] 张聪聪[1] 顾承雄[1] ZHANG Fan;ZHANG Congcong;GU Chengxiong(The 6th Ward,Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing,100029,P.R.China)

机构地区：[1]首都医科大学附属北京安贞医院心外科6病区,北京100029

出　　处：《中国胸心血管外科临床杂志》2021年第3期335-338,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金面上项目(81871758)。

摘　　要：目的使用即时血流测量仪(transit time flow measurement,TTFM)评价冠状动脉(冠脉)旁路移植术中吻合口探查疏通术使用前后对吻合口处血流参数的影响。方法纳入2018~2019年在北京安贞医院心外科行不停跳冠脉旁路移植术+吻合口探查疏通术的患者共167例,其中男136例、女31例,年龄41~82(58.35±17.26)岁。若探条进入和退出顺利,则记为无阻力组;若遇到阻力但能通过并退出,则记为有阻力组;若遇到明显阻力不能通过吻合口,则记为狭窄组。狭窄组需要拆除吻合口重新吻合后并使用TTFM进行流量测量。结果TTFM初次测量共发现流量不达标的吻合口202个。其中无阻力组吻合口87个(43.1%),经探查疏通术后复测的即时血流量(blood flow volume,BFV)和搏动指数(pulse index,PI)值与探查疏通术前无明显变化[(6.18±3.44)mL/min vs.(6.16±3.41)mL/min,P=0.90;6.96±2.49 vs.7.06±2.84,P=0.50],提示吻合口处无狭窄不需重新吻合口,可能为远端靶血管存在狭窄,需进一步进行冠脉内膜剥脱等处理;有阻力组吻合口64个(31.7%),经探查疏通术后复测的即时B F V值较探查疏通术前明显增加[(17.11±7.52)m L/m i nv s.(4.96±3.32)mL/min,P<0.01],PI值较探查疏通术前明显降低(3.78±2.20 vs.8.58±2.97,P<0.01);狭窄组吻合口51个(25.2%),经探查疏通术后复测的即时BFV和PI与探查疏通术前差异无统计学意义[(3.48±2.11)mL/min vs.(3.44±1.95)mL/min,P=0.84;10.54±4.11 vs.10.74±4.12,P=0.36],经重新吻合桥血管后测量的即时BFV[(16.48±7.67)mL/min]较探查疏通术前明显增加(P<0.01),PI(3.43±1.39)明显降低(P<0.01)。结论结合即时血流测量技术应用吻合口探查疏通术,可以减少二次吻合事件的发生,并及时发现和解决远端冠脉狭窄,改善冠脉灌注不良的问题,提高患者的手术预后。Objective To evaluate the changes of the flow parameters before and after the anastomotic port exploration and dredging during coronary artery bypass grafting by using the transit time flow measurement(TTFM).Methods A total of 167 patients who underwent continuous coronary artery bypass grafting and anastomotic port exploration and dredging surgery in Beijing Anzhen Hospital from 2018 to 2019 were enrolled in this study.There were136 male and 31 female patients aged 41-82(58.35±17.26)years.If the probe entered and exited the anastomotic port smoothly,it was recorded as a non-resistance group;if the resistance existed but the probe could pass and exit,it was recorded as a resistance group;if the probe could not pass the anastomotic port for obvious resistance,it was recorded as the stenosis group.In the stenosis group,the grafts were re-anastomosed and the flow parameters were re-measured by TTFM.Results A total of 202 anastomotic ports were carried out by exploration and dredging.Among them,87 anastomosis(43.1%)were in the non-resistance group,and there was no significant change in the blood flow volume(BFV)and pulsatility index(PI)before and after exploration and dredging(6.16±3.41 mL/min vs.6.18±3.44 mL/min,P=0.90;7.06±2.84 vs.6.96±2.49,P=0.50).Sixty-four anastomosis(31.7%)were in the resistance group,the BFV was higher after exploration and dredging than that before exploration and dredging(17.11±7.52 mL/min vs.4.96±3.32 mL/min,P<0.01),while the PI was significantly smaller(3.78±2.20 vs.8.58±2.97,P<0.01).Fifty-one anastomosis(25.2%)were in the stenosis group,and there was no significant change in the BFV and PI before and after exploration and dredging(3.44±1.95 mL/min vs.3.48±2.11 mL/min,P=0.84;10.74±4.12 vs.10.54±4.11,P=0.36).After re-anastomosis,the BFV was higher(16.48±7.67 mL/min,P<0.01)and the PI deceased(3.43±1.39,P<0.01)than that before exploration and dredging.Conclusion The application of anastomotic exploration and dredging can reduce the occurrence of re-anastomosis,and promptly find

关 键 词：不停跳冠状动脉旁路移植术 大隐静脉桥 吻合口探查疏通术 即时血流测量仪 

分 类 号：R654.2[医药卫生—外科学]