心脏不停跳冠状动脉旁路移植术中应用8-0 Prolene缝线的即时血流效果评价

Immediate Graft Flow Outcomes of 8-0 Prolene Sutures in Off-pump Coronary Artery Bypass Grafting

目的探索采用8-0 Prolene缝线进行移植血管远端吻合的即时效果。方法分别选取2010年和2012年在北京安贞医院心外科行不停跳冠状动脉旁路移植术的患者共101例,男87例、女14例,年龄46～82（61.35±8.24）岁。2010年的36例患者全部使用目前国内外常规使用的7-0 Prolene缝线缝合冠状动脉远端吻合口,2012年的65例患者全部使用8-0 Prolene缝线缝合冠状动脉远端吻合口。吻合完毕后全部应用即时血流测量仪测量与前降支吻合的移植血管（左乳内动脉和大隐静脉）的血流相关指标,包括血流量、搏动指数（PI）和舒张期血流灌注率,将分别应用7-0 Prolene和8-0 Prolene两种吻合缝线吻合的移植血管的测量数据进行比较。结果采用8-0Prolene缝线吻合的左乳内动脉桥（n=44）的血流量值较7-0 Prolene缝线吻合的左乳内动脉桥（n=30）血流量值明显增加[（33.70±21.13）ml/min vs.（27.50±17.34）ml/min,P=0.032],同时搏动指数明显减小（2.15±0.69 vs.2.58±1.01,P=0.047）。而8-0 Prolene缝线吻合后大隐静脉桥（n=21）的血流量值和搏动指数与7-0 Prolene缝线进行吻合的大隐静脉桥（n=6）差异无统计学意义[（34.19±16.00）ml/min vs.（29.00±15.48）ml/min,P〉0.05;2.07±0.53 vs.1.95±0.55,P〉0.05]。所有移植血管的舒张期血流灌注率均大于50%,且组间差异无统计学意义（P〉0.05）。结论使用8-0 Prolene缝线进行左乳内动脉与前降支的吻合可以提高移植血管的血流量同时降低其搏动指数,吻合口即时通畅性更佳,将有利于提高手术的成功率及预后。

Objective To evaluate immediate outcomes of 8-0 Prolene sutures for distal anastomosis during off- pump coronary artery bypass grafting （OPCAB）. Methods A total of 101 patients who underwent OPCAB in Depart- ment of Cardiac Surgery of Beijing Anzhen Hospital in 2010 and 2012 respectively were enrolled in this study. There were 87 male and 14 female patients with their age of 46-82 （61.35± 8.24）years. All the 36 patients in 2010 received 7-0 Prolene sutures for distal anastomosis, and the 65 patients in 2012 received 8-0 Prolene sutures for distal anastomosis. After anastomosis, transit time flow measurement was used to measure blood flow indexes of graft vessels [ left internal mammary artery （LIMA） and saphenous vein （SV） ] including blood flow volume （BFV）, pulsatility index （PI） and diastolic filling fraction （DF）, which were compared between patients receiving 7-0 and 8-0 Prolene sutures. Results BFV of LIMA grafts with 8-0 Prolene sutures （ n=44 ） was significantly larger than that with 7-0 Prolene sutures （n=30） [ （ 33.70±21.13 ） ml/min vs. （27.50± 17.34）ml/min, P=-0.032 ], while PI of LIMA grafts with 8-0 Prolene sutures was significantly smaller than that with 7-0 Prolene sutures （2.15_ 0.69 vs. 2.58 ±1.01, P=-0.047 ）. BFV and PI of SV grafts with 8-0 Prolene sutures （n=21） were not statistically different from those with 7-0 Prolene sutures （ n=6 ） [ （ 34.19 ± 16.00 ）ml/min vs. （ 29.00± 15.48 ） ml/min, P ～ 0.05; 2.07±0.53 vs. 1.95±0.55, P 〉 0.05]. DF of all the grafts was greater than 50%, and there was no statistical difference in DF between the 2 groups （P 〉 0.05）. Conclusion 8-0 Prolene sutures for LIMA-to-left anterior descending artery can improve BFV and decrease PI of LIMA grafts, which reflects better immediate graft patency of the distal anastomosis and helps improve surgical success rate and long-term prognosis.