双乳内动脉应用方式对冠状动脉旁路移植术中旁路移植血管血流的影响分析  

Graft flow analysis of application of bilateral internal mammary artery with different configurations in coronary artery bypass grafting

作　　者：韩增强[1] 王璇 周荣锋 刘刚[1] 陈彧[1] Han Zengqiang;Wang Xuan;Zhou Rongfeng;Liu Gang;Chen Yu(Department of Cardiac Surgery,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院心脏外科,北京100044

出　　处：《中华胸心血管外科杂志》2022年第8期465-469,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的:分析双侧乳内动脉(BIMA)不同的应用方式对冠状动脉旁路移植术(CABG)中旁路移植血管血流的影响。方法:回顾性分析2018年1月至2020年12月期间在北京大学人民医院心脏外科使用BIMA行CABG的82例患者临床资料,其中男75例,女7例;平均(56.9±9.8)岁。按照BIMA作用左、右冠状动脉靶血管不同,分为双侧组(B组,23例)和左侧组(L组,59例);按照右乳内动脉(RIMA)是否离断分为原位组(I组,57例)和游离组(F组,25例)。应用瞬时流量测定技术测量旁路移植血管血流各项参数,出院前行冠状动脉CTA检查评价旁路移植血管通畅情况。结果:围手术期死亡1例(1.22%)。旁路移植血管血流方面,与L组相比,B组中RIMA平均流量更高(P=0.013);与F组相比,I组中的左乳内动脉(LIMA)搏动指数值更低(P=0.007),RIMA平均流量更高(P=0.016),BIMA平均流量总和更高(P=0.033),且LIMA出现平均流量<15 ml/min的例数更少(P=0.023)。出院前复查冠状动脉CTA,1例RIMA到右冠状动脉旁路移植血管闭塞。结论:使用BIMA行CABG时,尽量使用原位乳内动脉。RIMA用于右冠状动脉比用于左冠状动脉时旁路移植血管血流更佳。BIMA早期通畅性好,是稳定理想的冠状动脉旁路移植物。Objective To analyze the influence of application of bilateral internal mammary artery(BIMA)with different configurations in coronary artery bypass grafting(CABG).Methods From January 2018 to December 2020,82 patients underwent CABG using BIMA were included,with 75 males and 7 females,aged(56.9±9.8)years old.According to the target of coronary artery of BIMA,patients were divided into two groups,23 patients(group B)who underwent the traditional operation(RIMA to the right coronary artery),and 59 patients(group L)whose RIMA were grafted to the left ventricular arteries.Also the patients were divided into two groups according to the RIMA used either in situ(group I,57 cases)or free(group F,25 cases).Compare the grafts flow between groups.The CTA angiography of coronary artery was completed to evaluate the grafts patency before discharge.Results There was 1 early operative death(1.22%).The mean flow(MF)of RIMA was significantly higher in group B(P=0.013).The pulsatility index(PI)of LIMA was significantly lower and the MF of RIMA and BIMA was higher(all P<0.05),fewer patients with LIMA-MF less than 15 ml/min(P=0.023)in the group I.CTA angiography before discharge showed that only 1 RIMA to right coronary artery was occlusion.Conclusion It is better to use BIMA in situ in CABG,RIMA used in right coronary artery can receive more satisfactory graft flow.BIMA has good patency in early stage,therefore is the ideal and stable coronary bypass graft.

关 键 词：冠状动脉旁路移植术 乳内动脉 瞬时血流测定 

分 类 号：R654.2[医药卫生—外科学]