冠状动脉左前降支狭窄程度与乳内动脉桥血流量的相关性研究

Relationship between stenosis of left anterior descending artery and left internal mammary artery blood flow

目的 了解非体外循环冠状动脉旁路术 (OPCAB)术中左前降支 (LAD)狭窄程度与左乳内动脉 (LIMA)桥血流量的相关性。 方法 将行OPCAB治疗的 16 7例患者 ,按LAD狭窄程度 (<75 %、75 %～ 95 %、>95 % )分为 3组 ,A组 31例、B组 6 2例、C组 74例 ,常规用LIMA与LAD吻合 ,吻合完毕时用即时超声血流探测仪直接测量并记录LIMA桥血流波形、平均流量、舒张期流量、收缩期流量、搏动指数 (PI)及平均动脉压 ,进行LIMA血流量的对比研究。 结果 3组间平均动脉压差异无显著意义 (P >0 0 5 ) ;C组LIMA桥平均血流量 (2 8 3± 3 2 )ml/min ,舒张期流量 (5 5 1± 5 3)ml/min ,均显著高于A组 [(11 1± 1 2 )、(2 6 3± 2 8)ml/min]和B组 [(16 3± 1 6 )、(34 8± 3 2 )ml/min](P均 <0 0 1) ;B组平均流量、舒张期流量大于A组 (P <0 0 1、P <0 0 5 ) ;PI值C组小于其他两组 (P <0 0 1) ,B组小于A组 (P >0 0 5 ) ;而收缩期流量各组之间差异均无显著意义 (P >0 0 5 )。结论 OPCAB中 ,LAD狭窄程度越高 ,LIMA桥血流量越大 ,PI值越小 ,而收缩期血流量与狭窄程度无关。

Objective To compare the blood flow of left internal mammary artery (LIMA) anastomosed to left anterior descending artery (LAD) with variable degree of stenosis in off pump coronary artery bypass grafting (OPCAB). Methods From 2000.9 to 2002.12, 167 cases (from a total of 209 OPCAB) were involved in this study. According to the degree of stenosis of LAD, all the cases were divided into group A(<75%), group B(75%～95%) and group C (>95%). Blood flow of LIMA, routinely anatomized to LAD was immediately measured after anastomosis with transit-time flowmeter (TTFM) and several parameters were recorded. Results The mean blood pressure at measurement was not significantly different (P=0.08). Mean blood flow of group A (11.1±1.2) ml/min, B (16.3±1.6) ml/min and C (28.3±3.2) ml/min and diastolic flow of group A (26.3±2.8) ml/min, group B (34.8±3.2)ml/min and group C (55.1±5.3) ml/min, were significantly different between every two groups (P<0.01) and the latter was bigger than the former. Systolic blood flow among group A(5.3±0.7)ml/min, group B (4.3±1.4)ml/min and group C (4.6±1.3)ml/min were not different (P=0.91). Pulsatility index (PI) of group C (2.75±0.14) was significantly smaller than that of group A(4.36±0.47)and group B(3.72±0.31)(P<0.01), but PI between groups A and B was of no significant difference (P=0.12). Conclusion Mean and diastolic blood flow of LIMA were closely related to the degree of stenosis of LAD. The higher the degree, the bigger the blood flow, and the smaller the value of PI. However, systolic blood flow was not influenced by the degree of lesion.