左乳内动脉旁路内逆向血流的影响因素研究

Clinical study on the influence factors of the retrograde flow in LIMA graft

目的研究冠状动脉旁路移植术(CABG)中左前降支(LAD)自身狭窄程度、有效侧支循环及左室前壁及前间壁有无活动异常对左乳内动脉(LIMA)旁路内逆向血流(RF)形成的影响。方法对CABG手术治疗中建立LIMA-LAD旁路的133例患者的LIMA旁路进行分析。按3种不同影响因素对比分成6组,测量各组患者LIMA-LAD旁路平均RF速度,分析诸因素对RF形成的各自影响程度。结果狭窄程度不同的两组间RF速度平均值统计学差异显著(P<0.01);具备及不具备有效侧支循环的两组间RF速度平均值存在统计学差异(P<0.05);另外两组间RF速度平均值无统计学差异(P>0.05)。结论来自LAD近端的自身血流可显著影响CABG术后LIMA-LAD旁路的瞬时血流灌注,是旁路内产生RF的重要因素,LAD有效侧支循环的建立也是RF的主要成因之一。RF与左室前壁及前间壁有无活动异常无明确相关性。

Objective To study the influence factors of the intraoperatively retrograde flow（RF） in the left internal mammary artery（ LIMA ）graft to the the left anterior descending artery（LAD） in coronary artery bypass grafting（CABG）. Methods One hundred and thirty-three patients underwent myocardial revascularization with LIMA to LAD had been studied. The RF velocity of the grafts was measured with transit time flow measurement（TTFM）. Data of the mean RF was analyzed with SPSS for Windows release 11.0 software. Results RF in LIMA graft was found in 89 patients（67 % ）. The mean RF velocity was （20.69 ± 5.19） ml/min in group A1 and （ 10.04 ± 4.39） ml/min in group A2 （ P 〈 0.01 ）, and （ 17.60 ± 4.92） ml/min in group B1 and （7.76 ± 3.00） ml/min in group B2（P〈0.05）, and （13.62 ± 4.67） ml/min in group C1 and （9.65 ± 4.99） ml/min in group C2（P〉 0.05）. Conclusions The native flow in LAD and the collateral blood flow to the LAD is the important factor to cause the RF in LIMA graft. When the stenosis in the LAD is mild with strong native blood flow, or the distal of the LAD with effective collateral circulation, the RF to the LIMA graft will be significant. There are no evidences indicating that abnormokinesia on the anterior or anterior-septal wall of the left ventricle contribute to the RF of a LIMA graft.