摘要
目的:通过超声瞬间血流仪在术中评估左胸小切口冠状动脉旁路移植术(MIDCAB)和胸骨正中切口非体外循环下冠状动脉旁路移植术(OPCAB)患者左乳内动脉(LIMA)桥的血流情况。方法:2013-01至2015-07期间300例患者接受OPCAB,LIMA全部与左前降支(LAD)吻合。70例患者采用MIDCAB,为MIDCAB组,同期有230例患者采用传统正中开胸OPCAB,为传统OPCAB组。术中应用即时血流测量技术对旁路血管进行血流测量。对比分析两组术前、术后的各项指标及LIMA桥血管的平均流量、搏动指数、舒张期充盈百分比和血流波形。结果:传统OPCAB组和MIDCAB组的手术输血量分别为(3.00±5.42)U和(1.06±2.17)U;术后心肌肌钙蛋白I(c Tn I)峰值分别是(2.84±9.93)ng/ml和(0.69±1.74)ng/ml;呼吸机使用时间分别是(27.90±66.90)h和(14.20±20.80)h;重症监护病房停留时间分别是(64.10±89.60)h和(35.20±39.20)h,两组差异均有统计学意义(P<0.05)。两组的LIMA至LAD的桥血管平均流量[(29.45±18.19)ml/min vs(29.04±15.85)ml/min]、搏动指数(2.68±1.19 vs 2.44±0.84)、舒张期充盈百分比[(71.47±11.12)%vs(70.25±11.30)%]的差异均无统计学意义(P均>0.05)。结论:进行LIMA至LAD搭桥,采用MIDCAB可取得与传统OPCABG同样的效果,术后早期吻合口质量可靠。
Objective：To compare the blood flow of left internal mammary artery（LIMA） graft vessel between minimally invasive direct coronary artery bypass（MIDCAB） and traditional median sternotomyin off-pump coronary artery bypass（Traditional OPCAB） by transit-time flow meter（TTFM）.Methods：We retrospectively studied 300 patients who received OPCAB in our hospital from 2013-01 to 2015-07,all patients had LIMA to left anterior descending coronary artery（LAD） anastomosis.The patients were divided into 2 groups：MIDCAB group,n=70 and Traditional OPCAB group,n=230.Intra-operative blood flow in graft vessel was measured by transit-time flow meter.Pre-and post-operative indexes and the mean flow（MF）,pulsatile index（PI）,diastolic fraction（DF） of LIMA graft were compared between 2 groups.Results：The following indexes in Traditional OPCAB group and MIDCAB group were as below：intra-operative transfusion was（3.00±5.42） U vs（1.06±2.17） U,post-operative peak value of c Tn I was（2.84±9.93） ng/ml vs（0.69±1.74） ng/ml,mechanical ventilation time was（27.9±66.9） h vs（14.2±20.8） h and ICU stay time was（64.1±89.6） h vs（35.2±39.2） h,all P〈0.05;while for the graft from LIMA to LAD,MF was（29.45±18.19） ml/min vs（29.04±15.85） ml/min,PI was（2.68±1.19） vs（2.44±0.84） and DF was（71.47±11.12） % vs（70.25±11.30） %,all P〉0.05.Conclusion：With LIMA to LAD graft,MIDCAB may achieve the same effect as traditional OPCAB,the early post-operative anastomosis has been reliable.
出处
《中国循环杂志》
CSCD
北大核心
2016年第10期981-983,共3页
Chinese Circulation Journal
