冠状动脉旁路移植术中旁路通畅性的评价

Assessment of coronary artery bypass patency by transit time flow meter technique

目的 探讨即时血流测量技术评估冠状动脉旁路通畅性的应用特点。方法 分析272例接受冠状动脉旁路移植术(CABG)患者的临床资料,术中共654根旁路应用即时血流测量技术进行流量测定,将血流量及血流波形存储在即时血流测量仪中。应用血流测量仪输出的关键值判断桥血管是否需要重新吻合。结果 对251例乳内动脉前降支旁路流量测定,平均血流量为(28.1±19.1)ml/min,搏动指数(PI值)2.96±2.05;对403根静脉旁路流量测定,其中对角支33根,平均血流量(34.3±28.6)ml/min,PI值2.18±0.63;钝缘支184根,平均血流量(37.6±27.9)ml/min,PI值3.05±2.12;右冠状动脉184根,平均血流量(36.2±24.2)ml/min,Pl值2.9±1.8。弥漫病变血管旁路血流量小,常规体外循环冠状动脉旁路移植术(cCABG)组回旋支序贯旁路远端吻合口多,血流量较非体外循环冠状动脉旁路移植术(OPCAB)组高。5例由于血液波形不满意拆除后进行了再次搭桥。结论 即时血流测量技术非常适合术中判断冠状动脉旁路通畅性。

Objective To investigate assessment of graft patency following coronary artery bypass graft (CABG) by transit time flow meter technique. Methods From June 2000 to Janunary 2002,272 patients underwent CABG with a total of 654 grafts. All grafts were examined intraoperatively by transit time flow measurement (TTFM). Date of flow measurement and flow curve was stored and analyzed by TTFM. whether an individual graft needed to be revised using key values from the TTFM output. Results Among 272 patients the left internal mammary grafts(LIMA) to the left anterior descending artery blood flow was measured in 251.The mean flow of LIMA graft flow was (28.1±19. l)ml/min with PI value 2. 96±2.05. 403 saphenous grafts were examed by TTFM, including 33 diagonal branches [mean blood flow (34.3±28.6)ml/min,PI 2.18±0.63], 184 obtuse marginal branches [mean blood flow (37.6±27.9)ml/min,PI 3.05±2.12], 184 right coronary artery [mean blood flow (36.2±24.2)ml/min, PI 2.9±1.8]. Five grafts(0.8%) were surgically revised because of an unsatisfactory flow curvas. The flow of OM in cCABG group with the multiple anastomosis site of sequential grafts was higher than that in OPCAB group. Diffused stenosis of coronary artery bypass grafts in both groups should less flow. Conclusions TTFM is well-suited for intraoperative assessment of coronary graft patency.