瞬时血流测量技术在不停跳冠状动脉旁路移植术中的应用

Transit-time flowmetery during off-pump coronary artery bypass grafting

目的在不停跳冠状动脉旁路移植术(Off-pump Coronary Artery Bypass Grafting,OPCAB)中应用瞬时血流测量仪(Transit-time Flowmetery,TTFM)测量血管桥的血流量,根据平均血流量、搏动指数(Pulsatility Index,PI)和血流曲线图,判定血管桥的通畅性,及时对不通畅的血管桥进行修正,提高手术效果。方法2001年7月—2005年6月,对256例OPCABG病例的498支血管桥进行血流测量,分析平均血流量、PI和血流曲线图。结果共15例16支血管桥测量结果显示平均血流量偏低、PI过高、血流曲线图不正常三种情况中的一种或几种,检查发现:乳内动脉损伤3支,静脉桥扭曲或旋转7支,吻合口狭窄4支,血管桥张力过大2支,总的血管桥修正率为3%(16/498)。结论TTFM测量血管桥血流量,简便可靠,重复性强,可及时发现不通畅的血管桥并纠正,确保手术效果。

Objective To assess the graft patency by measuring the blood flow with transit-time flow meter（TTFM） during Off-pump Coronary Artery Bypass Grafting（OPCAB）. Methods From July 2001 to June 2005, 256 patients underwent OPCAB and 498 grafts were constructed including 239 artery grafts and 259 vein grafts. Graft blood flow was measured and recorded using a multi-channel Medi-sfim Butterfly Flowmeter Doppler transit-time flow measurement system （Medi-Stim, Oslo, Norway）. Results 16 grafts in 15 patients presented low blood flow or/and high PI or/and unsatisfactory blood flow curves. After the revision of technique errors, the blood flow increased and PI decreased remarkably, also presented with a satisfactory blood flow curve with the blood filling was mainly during diastole of the heart. The total graft revision rate was 16/498. Conclusion Transit-time flow measurement is stable, reproducible and representative of the real flow within the constructed grafts, it allows reliable and straightforward evaluation of morphofunctional parameters of coronary artery bypass graft. It is clinically useful.