摘要
目的:分析比较两侧原位乳内动脉至前降支系统血运重建后的血流表现。方法:收集2017年10月至2019年10月期间363例在北京大学人民医院心外科行左侧乳内动脉至前降支旁路移植(LIMA-LAD)和右侧乳内动脉至前降支旁路移植(RIMA-LAD)的非体外循环下冠状动脉旁路移植术患者临床病例资料。按照不同动脉移植血管分为左侧乳内动脉移植血管组(LIMA-LAD组,329例)和右侧乳内动脉移植血管组(RIMA-LAD组,34例)。术前行经胸乳内动脉超声检查,术中使用TTFM测量并记录移植血管的血流量、搏动指数和舒张期血供比例(DF值)等参数,术后1周行冠状动脉CTA检查。结果:术前右侧乳内动脉相较于左侧直径更粗、流量更大、搏动指数更优( P<0.05)。吻合于前降支系统后,左、右两侧乳内动脉旁路移植血管在流量、搏动指数和DF值方面差异均无统计学意义( P>0.05)。右侧骨骼化获取的原位乳内动脉旁路移植血管并未体现出血流量增加的优势。与术前自身乳内动脉血流相比,术中左或右侧乳内动脉旁路移植血管在血流量和搏动指数方面均明显改善( P<0.001)。考虑到两组间年龄因素差异巨大,使用倾向性评分匹配后再次比较流量、搏动指数以及DF值,组间差异仍均无统计学意义( P>0.05)。术后1周LIMA-LAD组完成冠状动脉CTA检查313例,其中4例存在不同程度问题。RIMA-LAD组34例均完成冠状动脉CTA检查,1例提示远端显影浅淡,余者结果未见明显异常。两组在术后冠状动脉CTA完成率( P=0.381)和旁路移植血管失败率( P=0.405)方面差异均无统计学意义。 结论:与术前自身乳内动脉血流相比,术中左、右两侧乳内动脉旁路移植血管的血流量、搏动指数均显著改善。尽管术前右侧乳内动脉血流参数优于左侧,但吻合于前降支靶血管后两组在流量、搏动指数以及DF值方面差异均无统计学意义。骨骼化获取的乳内动脉移植�
Objective To analyze and compare difference of ultrasonic blood flow of left internal mammary artery(LIMA)and right internal mammary artery(RIMA)as graft to left anterior descending artery(LAD)in patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods From October 2017 to October 2019,a total of 363 patients who underwent OPCAB including 329 patients in LIMA-LAD group and 34 patients in RIMA-LAD group,were included in this study.Transthoracic ultrasound examination on IMA was performed before OPCABG.The blood flow,the value of PI(pulsation index)and diastolic flow(DF)of LIMA and RIMA to left anterior descending were measured and recorded by intraoperative TTFM.Patients underwent coronary artery CT examinations at 1 week after OPCABG to discover the patency of grafts.Results The pre-operative diameter of RIMA was larger and the blood flow and pulsation index of RIMA was better than that of LIMA before OPCABG(P<0.001).But there was no significant difference in the flow,pulsation index and DF value of graft between the two groups after IMA were anastomosed to LAD(P>0.05).In situ skeletonized graft of RIMA did not show the advantage of increased blood flow.Compared with the preoperative parameters of flow of internal mammary artery,both the left and right grafts of IMA were significantly better in blood flow and pulsation index(P<0.001).Considering the remarkable difference in age between the two groups,Flow,PI and DF were compared again after propensity score matching,and there was still no statistical difference between the two groups(P>0.05).A total of 313 patients in LIMA-LAD group completed coronary CTA examination one week after surgery,among which 4 grafts had different degrees of problems.A total of 34 patients in RIMA-LAD group completed coronary CTA examination,one case indicated that the CTA imaging in distal segment was not clear,and the other results had no obvious abnormality.There was no significant difference in postoperative rate of coronary CTA completion(P=0.381)and rate of gra
作者
赵舟
张国栋
张显贵
廉波
刘刚
陈生龙
陈彧
Zhao Zhou;Zhang Guodong;Zhang Xiangui;Lian Bo;Liu Gang;Chen Shenglong;Chen Yu(Department of Cardiac Surgery,Heart Center,People’s Hospital of Peking University,Beijing 100044,China)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2021年第1期23-28,共6页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
乳内动脉
冠状动脉旁路移植术
瞬时血流测定
经胸乳内动脉超声
Internal mammary artery
Coronary artery bypass grafting
Transit-time flowmeter
Transthoracic arterial ultrasound
