骨骼化胸廓内动脉在冠状动脉旁路移植术中的应用优势  

Advantages of using skeletonized internal thoracic artery for coronary artery bypass grafting

作　　者：亓先杰 王亚涛 魏婷 刘戈[1] 姜亦瑶 施超[1] QI Xianjie;WANG Yatao;WEI Ting;LIU Ge;JIANG Yiyao;SHI Chao(Department of Cardiac Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院心脏外科,安徽蚌埠233004

出　　处：《中华全科医学》2023年第3期374-376,416,共4页Chinese Journal of General Practice

基　　金：国家自然科学基金青年科学基金项目(81800214);安徽省自然科学基金青年项目(1808085QH236);蚌埠医学院转化医学重点项目(BYTM2019041);蚌埠医学院2021年度研究生科研创新计划项目(Byycx21077)。

摘　　要：目的 骨骼化胸廓内动脉广泛应用于冠状动脉旁路移植术中,本研究对骨骼化胸廓内动脉与术后胸壁疼痛及感觉异常的相关性进行分析。方法 选取2020年9月—2021年1月蚌埠医学院第一附属医院70例体外循环下冠状动脉旁路移植术患者进行回顾性分析。其中36例患者为骨骼化胸廓内动脉移植物,另外34例患者为带蒂胸廓内动脉移植物。结果 术中测得骨骼化胸廓内动脉移植物组胸廓内动脉桥血管流量为42.0(33.0,53.5)mL/min、搏动指数为2.75(2.15,3.60)与带蒂胸廓内动脉移植物组[41.0(27.0,51.0)mL/min、3.10(2.20,3.60)]比较差异无统计学意义(均P>0.05);术后1个月,骨骼化胸廓内动脉移植物组的疼痛残疾指数[3(2,3)]低于带蒂胸廓内动脉移植物组[5(4,5),P<0.05];术后1个月、1年,骨骼化胸廓内动脉移植物组的感觉异常发生率低于带蒂胸廓内动脉移植物组,差异有统计学意义(均P<0.05)。结论 骨骼化胸廓内动脉移植物能够提供不逊色于带蒂胸廓内动脉移植物的桥血管流量,并且不增加桥血管搏动指数(流体阻力)。长期来看,骨骼化胸廓内动脉能降低术后胸壁感觉异常发生率,但不能减少冠状动脉旁路移植术后疼痛。Objective Skeletonized internal thoracic arteries(ITA) are widely used in coronary artery bypass grafting.The aim of this study is to analyze the correlation between the skeletonized internal thoracic artery and postoperative chest wall pain and paresthesia.Methods Seventy patients who underwent coronary artery bypass grafting with extracorporeal circulation in the First Affiliated Hospital of Bengbu Medical College from September 2020 to January 2021 were selected for retrospective analysis.Among them,36 patients had skeletonized ITA grafts and 34 patients had pedicled ITA grafts.Results There were no significant differences in the mean flow and pulse index of ITA grafts between skeletonized ITA grafts [42.0(33.0,53.5) mL/min,2.75(2.15,3.60)] and pedicled ITA grafts [41.0(27.0,51.0) mL/min,3.10(2.20,3.60)],all P>0.05.At 1 month postoperatively,the pain disability index was lower in the skeletonized ITA graft group [3(2,3)] than in the pedicled ITA graft group [5(4,5)],and the difference was statistically significant(P<0.05).The incidence of paresthesia was lower in the skeletonized ITA graft group than in the pedicled ITA graft group at 1 month and 1 year postoperatively,with statistically significant differences(both P<0.05).Conclusion Skeletonized ITA grafts are able to provide bridge vessel flow that was not inferior to that of pedicled ITA grafts and do not increase the bridge vessel pulsatility index(fluid resistance);In the long term,skeletonization of the ITA can reduce the incidence of postoperative chest wall paresthesia,but does not reduce post-coronary artery bypass grafting pain.

关 键 词：冠状动脉旁路移植术 骨骼化胸廓内动脉 桥血管流量 疼痛 感觉异常 

分 类 号：R654[医药卫生—外科学]