经胸多普勒显像评估内乳动脉血流特征在冠状动脉搭桥围术期的应用

Use of Doppler imaging in assessment of perioperative flow characteristics of internal mammary artery in myocardial revascularization

目的评估经胸超声多普勒频谱分析冠状动脉搭桥术(CABG)后内乳动脉血流特征的价值。方法62例择期CABG患者行左内乳动脉与左前降支吻合术。术前及术后2周于静息态和Azoulay手法下经左胸骨旁第一肋间行超声多普勒频谱内乳动脉血流评估。结果围术期内乳动脉内径无显著改变,多普勒显像由术前三相波形变为术后二相波形,收缩期峰值流速(PSV)显著降低〔由(54.5±26.4)cm/s降为(26.6±12.2)cm/s,P=0.0061〕,舒张期峰值流速(PDV)显著升高〔由(8.7±3.8)cm/s升为(18.9±12.4)cm/s,P=0.0037〕,搏动指数及阻力指数显著降低。使用Azoulay手法后,91.5%(54/59)舒张期、收缩期峰值流速比率(PDSVR)>1,提示内乳动脉血流通畅,余8.5%(5/59)比率<1,但>0.6,提示内乳动脉限制性血流特性。结论经胸多普勒显像评估内乳动脉血流特征是一项无创、易行的CABG后疗效评价方法。

Objective To assesstheinternal mammary artery conduit patency using transthorcic Doppler spectrum analysis. Mechods All 62 patients underwent anastomosis of the left IMA to left anterior descending artery. Transducer was placed at the first intercostal space at the left sternal border to measure the IMA diameter and the Doppler flow vdocity preoperatively and two weeks postoperatively at rest and during Azoulay maneuver. Results The luminal diameter of the left IMA didn＇t change perioperatively, preoperative Doppler triphasic wave had been converted into a combined systolic-diastolic wave form. Peak systolic velocity of the IMA was decreased （54.5±26.4cm/s vs 26.6±12.2cm/s,P=0.0061）, and peak diastolic velocity was increased （8.7±3.8cm/s vs 18.9±12.4cm/s , P=0.0037） significantly in the postoperative period compared with those of the preoperative values. Pulsatility index was and impedence index decreased significantly. Peak diastolic to systolic velocity ratios was increased greater than 1 in 54 cases during Azoulay maneuver. The ratios increased less than 1, but still greater than 0.6 in the rest five cases, indicating restricted but not occluded IMA conduit flow. Conclusions Transthoracic Doppler imaging is a noninvasive; easy method to evaluate the IMA conduit patency in myocardial revascularization.