非体外循环下冠状动脉旁路移植术中心外膜超声评价左前降支桥血管的临床研究

Clinical study of graft-left anterior descending artery assessment in off-pump coronary artery bypass graftingwith intraoperative epicardial echocardiography

目的探讨术中心外膜超声（IEE）在非体外循环下冠状动脉旁路移植术（OPCABG）术中评估冠状动脉左前降支（LAD）桥血管的临床应用价值。方法采用IEE对53例OPCABG患者的桥血管-LAD吻合口进行检测，灰阶超声及彩色多普勒超声显示桥血管-LAD吻合口近端及远端管腔内是否存在异常回声，测量内径及狭窄率，脉冲多普勒超声测量桥血管血流频谱及血流量，同时应用术中瞬时血流测量仪（TTFM）测量桥血管搏动指数和血流量参数。结果53例冠状动脉左前降支OPCABG患者中，左乳内动脉桥（LIMA）38例，大隐静脉桥（GsV）15例，TTFM测量搏动指数和血流量参数均显示为正常。使用lEE检测桥血管-LAD吻合口近端和远端的显示率均为100％，其中检出吻合口斑块10例，冠状动脉LAD吻合口近端斑块10例。术中IEE与TTFM测量桥血管血流量参数比较，LIMA桥血管两者之间差异无统计学意义（P=0．1191），而相关性具有统计学意义（r=0．809，P〈0．001）；GSV桥血管差异两者之间亦无统计学意义（P=0．821），而相关性具有统计学意义（r=0．684，P=0．005）。结论IEE可清晰显示桥血管及LAD的管腔结构，测量血流动力学指标，为OPCABG术中检测桥血管通畅性提供了一种直观、准确、便捷的新方法。

Objective To study the clinical value of intraoperative epicardial echocardiography （IEE） in assessing graftqeft anterior descending artery （LAD） of off-pump coronary artery bypass grafting （OPCABG）. Methods IEE was used to detecte graft vessels anastomosis in 53 patients with OPCABC LAD. Two-dimensional grey ultrasound and color Doppler ultrasound was used to show whether there was abnormal echo in proximal and distal lumen, measuring diameter and rate of stenosis. Pulse Doppler ultrasound was used to observe the blood flow spectrum. Intraoperative transient blood flow meter （TTFM） was employed to measure the pulsatility index and flow volume. Results Among the 53 patients with OPCABCLAD,38 cases were left internal mammary artery graft （LIMA）, 15 cases were saphenous vein graft （GSV）. Pulsatility index and flow volume showed normal by TTFM. The detection rates of graft vessels-LAD anastomosis in proximal and distal segment were 100% using IEE, including 10 cases anastomotic plaques and 10 cases proximal plaques. Comparison of blood flow parameter of graft by IEE and TTFM in operation, there was no significant difference in LIMA grafts （ P = 0. （191）, but the correlation was statistically significant （ r = 0,809, P 〈 0.001 ） ; the difference in GSV grafts had no statistical significance （ P = 0.821 ）, but the correlation was statistically significant （ r = 0.684, P = 0.0051. Conclusions IEE clearly displays the lumen of graft vessel and LAD, and measures the hemodynamic indexes. It provides an intuitive, accurate and convenient method for detecting the patency of the graft vessels during OPCABG.