非常规情况下使用大隐静脉替代左侧乳内动脉实施前降支再血管化治疗的围术期表现  

Perioperative manifestations of SVG instead of LIMA bypass to LAD in the unconventional condition

作　　者：赵舟[1] 张显贵 张国栋 廉波[1] 刘刚[1] 陈生龙[1] 陈彧[1] ZHAO Zhou;ZHANG Xiangui;ZHANG Guodong;LIAN Bo;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,北京100044

出　　处：《临床心血管病杂志》2020年第12期1125-1130,共6页Journal of Clinical Cardiology

基　　金：北京大学人民医院研究与发展基金(No:RDY2019-23)。

摘　　要：目的:研究非常规情况下使用大隐静脉(SVG)替代原位左侧乳内动脉(LIMA)作为前降支(LAD)的桥血管是否有助于提升桥流量等相关参数,同时观察静脉桥围术期的临床表现,以指导临床实践。方法:选取2017年11月—2019年9月于我院心外科实施冠状动脉旁路移植术(CABG)患者共计374例,其中LIMA-LAD组332例,SVG-LAD组42例。入选人群术中使用瞬时血流仪(TTFM)测量并记录桥血流量(MGF)、搏动指数(PI)和舒张期血供比例(DF)等参数。术后1周行冠状动脉(冠脉)CT检查明确桥血管通畅情况。结果:相较于LIMA-LAD组,SVG-LAD组的术中瞬时桥MGF更高[(29.70±20.97)ml/min∶(37.85±23.28)ml/min,P=0.021],PI(2.65±1.01∶2.12±0.68,P<0.001)也更优。使用倾向性评分校准年龄因素后,尽管流量上SVG-LAD组仍高于LIMA-LAD组,但差异不具有统计学意义[(29.92±21.92)ml/min∶(37.27±24.31)ml/min,P=0.109],而PI方面SVG-LAD组则依然更优(2.74±1.02∶2.07±0.63,P<0.001)。两组术后围术期心肌梗死发生率和肌酸激酶同工酶(CK-MB)水平无统计学差异。术后1周LIMA-LAD组313例完成冠脉CT检查,其中4例存在不同程度的问题。SVG-LAD组40例均完成冠脉CTA检查,结果未见明显异常。两组冠脉CT完成率和桥失败率无统计学差异。结论:SVG-LAD搭桥并不具有高流量优势,但相较于LIMA,SVG桥的PI更优。术后1周冠脉CT检查未显示SVG桥和LIMA桥在通畅率方面存在统计学差异。Objective:To investigate whether the use of the graft of great saphenous vein(SVG)to replace the left internal mammary artery(LIMA)for left anterior descending branch(LAD)in unconventional cases would be conductive to improve the flow of graft and other related parameters of TTFM,and to observe the clinical outcomes of the graft of saphenous vein during the perioperative period,and to guide the clinical practice.Method:A total of 374 patients who underwent coronary artery bypass grafting(CABG)from November 2017 to September 2019 were included and divided into the LIMA-LAD group(n=332)and SVG-LAD group(n=42).The mean graft flow(MGF),pulsatility index(PI),and diastolic flow(DF)were measured and recorded by intraoperative TTFM.Coronary CT examination was performed 1 week after the operation to determine the patency of the graft.Result:Compared with the LIMA-LAD group,the MGF in SVG-LAD group was higher[(29.70±20.97)ml/min vs.(37.85±23.28)ml/min,P=0.021],and the value of PI was better(2.12±0.68 vs.2.65±1.01,P<0.001).After adjusting for age with PSM,MGF in the SVG-LAD group was still higher than that in the LIMA-LAD group,but the difference was not statistically significant[(29.92±21.92)ml/min vs.(37.27±24.31)ml/min,P=0.109],the value of PI in SVG-LAD group was still better(2.74±1.02 vs.2.07±0.63,P<0.001).There was no significant difference in the incidence of myocardial infarction and CK-MB levels during the perioperative period between the two groups.A total of 313 patients in the LIMA-LAD group completed coronary artery CT examination one week after surgery,and four of them existed problems of different degrees.All 40 patients in the SVG-LAD group underwent CTA examination and no positive result was found.There was no statistical difference between the rate of coronary artery CT completion and the rate of graft failure.Conclusion:The usage of SVG bypass to LAD does not have the advantage of high MGF,but represent a better value of PI compared with the in-situ LIMA graft.One week after CABG,coronary artery C

关 键 词：冠状动脉旁路移植术 瞬时血流测定 乳内动脉 大隐静脉 

分 类 号：R654.3[医药卫生—外科学]