Coronary bypass revascularization with radial artery and internal mammary artery grafts  

桡动脉和内乳动脉在冠状动脉旁路术中的应用(英文)

作　　者：甄文俊[1] 佟宏峰[1] 王永忠[1] 孙耀光[1] 黄文[1] 马玉健[1] 田家政[1] 吴良洪[1] 

机构地区：[1]卫生部北京医院心胸外科,北京100730

出　　处：《Chinese Medical Journal》2002年第1期55-57,146,共3页中华医学杂志（英文版）

摘　　要：Objective To evaluate radial artery (RA) and internal mammary artery (IMA) grafts in coronary artery bypass and the use of color Doppler ultrasound in the peri-operative evaluation of IMA and radial-ulnar collateral circulation.Methods From June 1998 to June 2000, sixty cases of coronary bypass revascularization with RA and IMA were performed. Preoperatively, the radial-ulnar collateral circulation was evaluated with the modified Allen’s test, color Doppler ultrasound and noninvasive oxygen saturation measurement. The IMA lumen and blood flow were measured at the first intercostal space with color Doppler ultrasound preoperatively and postoperatively.Results One patient (1.7%) died of serious cardiac arrhythmia on the fourth postoperative day. There were no arterial graft harvest related complications. Before harvesting, the ulnar artery blood flow was 30.78±9.71?ml/min, and it increased to 43.36±13.98?ml/min (40.87% increase, P【0.01) after the operation. Compared with the baseline, there was no obvious change of IMA blood flow postoperatively (P】0.05), but the systolic/diastolic flow ratio markedly decreased from 8.57±3.98?ml/min to 3.41±4.87?ml/min (P【0.01).Conclusions Arterial grafts can be safely used for coronary bypass revascularization with good results. The ulnar artery blood flow can increase compensatively after RA harvesting. The diastolic blood flow of grafted IMA markedly increased postoperatively. Color Doppler ultrasound was very helpful both in evaluating the radial-ulnar collateral circulation before RA harvesting and in assessing the patency of the grafted IMA after coronary artery bypass grafting (CABG).目的　评价桡动脉 (RA)和内乳动脉 (IMA)在冠状动脉旁路移植术中的应用价值 ,以及彩色多普勒术前对评估桡-尺动脉侧枝循环 ,术后对判断IMA通畅程度的中的作用。方法　自 1998年 6月至 2 0 0 0年 6月 ,以RA和IMA为移植材料完成冠状动脉旁路移植术 (CABG) 6 0例。术前采用改良Allen试验、拇指血氧饱和度检查量化Allen试验、彩色多普勒对桡 -尺动脉侧枝循环进行评估 ,筛选RA取材患者。术前及术后在第一肋间以彩色多普勒检查IMA的口径及血流情况。结果　一例患者 (1 7%)术后第 4日死于恶性心律失常。无与动脉材料获取有关的并发症。术后 14日彩色多普勒检查 ,RA获取侧的尺动脉血流量由术前的 30 78± 9 71增加为 4 3 36± 13 89ml/min ,增加了 4 0 87%(P <0 0 1) ;IMA总的血流量无明显变化 ,但舒张期血流显著增加 ,收缩期 /舒张期血流速度比例由 8 5 7变为 3 4 1(P <0 0 1)。结论　动脉材料用于冠状动脉旁路手术安全可靠 ,效果良好。RA获取后 ,同侧前臂的尺动脉发生明显的代偿性扩张和血流增加。IMA移植后舒张期血流明显增加。术前彩色多普勒检查对评估桡 -尺动脉侧枝循环 ,以及术后对IMA通畅程度的判断有重要价值。

关 键 词：coronary artery bypass   ·  radial artery  ·  internal mammary artery  ·  Doppler ultrasound 

分 类 号：R654.2[医药卫生—外科学]