非体外循环下左乳内动脉序贯吻合的流量测定与临床应用

Flow of sequential left internal mammary artery grafting in an off-pump coronary bypass graft and its clinical assessment

目的探讨非体外循环下左乳内动脉序贯法冠状动脉旁路移植的可行性,为该技术的临床应用提供理论依据。方法2006年3月至2008年2月接受非体外循环下左乳内动脉冠状动脉旁路移植的患者72例,其中利用左乳内动脉序贯吻合者36例(A组);左乳内动脉仅与左前降支做端侧吻合者36例(B组)。吻合完毕,待循环稳定后,利用即时血流检测仪进行左乳内动脉旁路血管的流量测定。运用SPSS10.0软件对相关数据进行统计学处理及分析。结果A组患者左乳内动脉序贯旁路移植后,主干平均血流为(31±5.6)mL/min,搏动指数(PI)为2.0±0.3;B组左乳内动脉与前降支旁路移植后主干平均血流为(21±2.8)mL/min,PI为2.7±0.4;两组差异均有统计学意义(P均<0.01)。结论左乳内动脉既能满足前降支、对角支和中间支甚至更广泛区域缺血心肌的血供需求,又能保证冠状动脉旁路的动脉化,提高远期通畅率。

Objective To review the feasibility of sequential left internal mammary artery （LIMA）grafting in an off-pump coronary artery bypass graft（OPCABG）, and to present an objective evidence for clinical application. Methods Between March 2006 and February 2008, 72 consecutive patients who had undergone OPCABG with LIMA bypass grafts were included in this study. 36 patients with sequential LIMA grafting were enrolled into group A and the other non-sequential patients into group B. LIMA＇s blood flow was measured when the hemedynamics stabilized after the grafts were finished with the Medi-stim Butterfly Flowmeter. SPSS10.0 statistic software was used for analysis. Results Mean flow and Pulse index （PI） of the LIMA were significantly different between group A and B： （31 ± 5.6 ） mL/min versus （21 ± 2.8） mUmin and 2.0 ±0.3 versus 2.7 ± 0.4 respectively（ P〈0.01 ）. Conclusion The LIMA can provide an adequate blood flow for the myocardium supplied by diagonal, intermediat remus, left interventricular branch and even more areas. It can also ensure arterialization of a coronary bypass graft for a long-term patency rate.