非体外循环冠状动脉旁路移植术应用7-0或8-0 prolene缝线的移植物血管瞬时流量比较研究

Comparative study on transit-time flow measurement of graft conduits with 7-0 or 8-0 prolene suture applied for off-pump coronary artery bypass grafting

目的在非体外循环冠状动脉旁路移植术(OPCABG)中,比较应用7-0 prolene缝线与8-0 prolene缝线行移植物血管远端吻合后的瞬时血流效果。方法回顾性分析西京医院心血管外科由单一主刀医师完成的OPCABG病例。2019年7月~2020年6月移植物血管远端吻合使用7-0 prolene缝线,2020年7月~2021年6月移植物血管远端吻合使用8-0 prolene缝线。7-0 prolene缝线组纳入421个吻合口,8-0 prolene缝线组纳入397个吻合口。研究对象为移植物血管的瞬时流量测定(TTFM)指标:平均血流量值(MFV),搏动指数(PI)与舒张期充盈百分数(DF)。结果与7-0 prolene缝线组(n=421)相比,8-0 prolene缝线组移植物血管的MFV(ml/min)显著增加(36±13)vs.(46±16),P<0.05,PI显著降低(2.7±0.65)vs.(2.2±0.5),P<0.05;以不同靶血管做亚组分析,两组的PI在PL或PDA上无显著差异,在LAD上数值上8-0 prolene缝线组(升高)优于7-0 prolene缝线组(P<0.01)。在其余6个亚组上8-0 prolene缝线组的MFV与PI均(升高)优于7-0 prolene缝线组,差异有统计学意义(均P<0.05)。以不同移植物血管材料做亚组分析,8-0 prolene缝线组的MFV均(升高)优于7-0 prolene缝线组(均P<0.05),PI的IMA或RA(P<0.01)、SVG(P<0.05)均(升高)优于7-0 prolene缝线组。两组的DF(%)无显著差异(71±7)vs.(72±12)。结论在OPCABG移植物血管的远端吻合中使用8-0 prolene缝线可获得更优良的吻合质量。在患者的血管条件与医师的技术能力允许的前提下,应尽可能使用8-0 prolene缝线吻合以提高吻合质量。

AIM To compare the transit-time flow measurement results of graft conduits with 7-0 prolene suture and 8-0 prolene suture in off-pump coronary artery bypass grafting(OPCABG).METHODS OPCABG cases completed by a single surgeon in the Department of Cardiovascular Surgery in Xijing Hospital were analyzed retrospectively.7-0 prolene suture was used for distal graft conduit anastomosis from July 2019 to June 2020 and 8-0 prolene suture was used for distal graft conduit anastomosis from July 2020 to June 2021.421 anastomoses were included in the 7-0 Prolene suture group and 397 anastomoses were included in the 8-0 Prolene suture group.Transit-time flow measurement indexes of graft conduits,including mean blood flow(MFV),pulsatility index(PI)and diastolic filling percentage(DF%),were compared between the use of 7-0 prolene suture and 8-0 prolene suture.RESULTS Compared with 7-0 Prolene suture group(n=421),MFV(ml/min)of graft vessels in 8-0 Prolene suture group increased significantly(36±13 vs.46±16,P<0.05),and PI decreased significantly(2.7±0.65 vs.2.2±0.5,P<0.05);In subgroup analysis with different target vessels,there was no significant difference in PL or PDA between the two groups.In lad,the value of 8-0 Prolene suture group(increased)was better than that of 7-0 Prolene suture group(P<0.01).In the other six subgroups,the MFV and PI of 8-0 Prolene suture group were better than that of 7-0 Prolene suture group(all P<0.05).Using different graft vascular materials for subgroup analysis,the MFV of 8-0 Prolene suture group was better than that of 7-0 Prolene suture group(all P<0.05),and the ima or RA(P<0.01)and SVG(P<0.05)of PI were better than that of 7-0 Prolene suture group.There was no significant difference in DF(%)between the two groups(71±7 vs.72±12).CONCLUSION The use of 8-0 prolene sutures in distal anastomosis of OPCABG resulted in better anastomotic quality.8-0 prolene suture should be used to improve the quality of anastomosis if the patient’s vascular conditions and the surgeon’s technical competence allow.