CABG术中即时血流监测对桥血管通畅性的评价

Intraoperative Assessment of Coronary Bypass Flow by the Transit Time Measurement

目的:应用即时血流监测技术评价CABG术中桥血管通畅性,以便早期发现低血流量并及时给予纠正。方法:1999～2001年,采用即时血流监测仪对69例165根桥血管血流量进行监测,同时纪录体循环血压,观察即时心电图的变化及桥血管远端的病变情况。结果:术中应用乳内动脉60根,平均血流量19.32±17.33ml/min。应用大隐静脉桥共105根,其中对角支22根,平均血流量25.75±20.15ml/min;回旋支43根,平均流量46.56±25.68ml/min;右冠状动脉41支,平均血流量34.08±20.21ml/min。平均搏动指数3.01±1.58。3根(1.8％)桥血管血流量低,血流波形不满意,且搏动指数增高,其中2根为吻合口狭窄,1例为血管扭曲,经重新修正后恢复正常。结论:即时血流监测作为评价桥血管通畅性的一种方法,其技术操作方便、可靠,值得在临床上推广应用。

Objective: To assess intraoperative flow of coronary grafts after CABG which may allow early detection of low flow situations, and immediate correction of technical problems. Methods; We measured the blood flow of 60 internai marnma-ry artery (IMA) and 105 saphenous vein (SV) grafts constructed in 69 patients undergoing CABG from December 1999 to March 2001 using the transit time flow measurement (TTFM). Results: The mean flow was19. 32 ± 17. 33ml/min for 60 IMA , 25.75 ± 20.15ml/min for 22 vein graft to diagonal ,46.56±25. 68ml/min for 43 vein graft to OM, and 34.08120. 21ml/min for 41 vein graft to PDA/RA. Mean pulsatility index(PI) was 3.01 ±1.58. Three anastomosis (1.8%) were cor-recfed based on low flow and high PI. Conclusion: TTFM is a reliable method for assessing IMA and SV patency during CABG, considering the simple technical application, the procedure may be regarded as a valuable instrument of quality control.