超声对冠状动脉搭桥术桥血管—桡动脉选择的临床研究

Selection of radial artery as a coronary artery bypass graft with ultrasound

目的探讨超声在冠状动脉搭桥术(CABG)选择桡动脉作为桥血管的主要条件。方法对拟行CABG的216例患者进行Allen试验。超声检测桡动脉、尺动脉及拇指主要动脉(TA),记录管壁情况,测量血流峰值速度,记录桡骨茎突水平及其上方5cm处桡动脉内径,压迫桡动脉后检测侧支循环情况。对桡动脉作为桥血管的CABG病例术后随访半年以上。结果 216例患者中,Allen试验阳性者39例,超声发现16例患者桡动脉管壁有斑块及/或管腔狭窄,3例患者TA为桡动脉依赖型,与超声检查结果比较,Allen试验假阳性率高,二者比较差异有统计学意义(P<0.01)。超声提示197例患者TA为非桡动脉依赖型,压迫桡动脉后尺动脉峰速度明显增加,桡动脉桡骨茎突水平与其上方5cm处血管内径比较差异无统计学意义,其中桡动脉桡骨茎突水平内径≥1.8mm者160例,占81.2%。结论①桡动脉作为CABG桥血管的选择条件为管壁无钙化斑、无狭窄;TA为非桡动脉依赖型;桡动脉远段管腔内径≥1.8mm。②桡动脉内径测量段在茎突至其上方5cm内任意位置均可。超声筛查桡动脉作为CABG桥血管具有方便、无创及准确等优点,临床可推广应用。

Objective To explore the main condition of radial artery （RA） as coronary artery bypass grafting （CABG） with ultrasound. Methods Two hundred and sixteen patients who would receive CABG underwent Allen test. The patient＇s RA, ulnar artery and thumb main artery （TA） were examined by ultrasound, blood vessel wall lesions, hemodynamic parameters and internal diameter of RA on the level of malleolus radialis and 5 cm above the malleolus radialis were recorded, and collateral circulations of RA were examined when RA was oppressed. The patients received CABG with RA as a graft were followed up more than half a year. Results In the 216 cases, Allen test showed positive results in 39 cases, ultrasound examination revealed 16 cases of RA wall plaque and/or lumen stenosis, 3 cases was RA-dependent. Compared with ultrasound results, Allen test false positive rate was higher, there was significant difference （P 〈 0.01 ）. In 197 non-radial artery dependent cases, ulnar artery peak velocity was increased significantly when the radial artery was oppressed. There was no significant difference of RA internal diameter between the level of malleolus radialis and 5 cm above the malleolus radialis. There were 160 cases （81.2%）with the internal diameter of RA ≥ 1.8 mm on the level of malleolus radialis. Conclusion The conditions of RA suitable for CABG graft show as follow： without calcified plaque on the blood vessel wall, without lumen stenosis; non-radial artery dependence, and the RA＇s distal internal diameter ≥ 1.8 mm. The RA＇s internal diameter can be examined on any position between the level of malleolus radialis and 5 cm above the malleolus radialis. Ultrasound screening RA grafts for CABG should be popularized and applied for it is convenient, non-invasive and accurate.