体外与非体外循环冠状动脉旁路移植术对左主干病变患者桥血管的影响

Effect of extracorporeal and non-extracorporeal coronary artery bypass grafting on graft blood flow in patients with left main coronary artery lesion

  • 摘要: 目的 比较不同手术方式对左主干病变桥血管的影响。 方法 选取我院2010年1月-2011年12月因冠心病左主干病变而接受手术治疗的患者132例,男性98例,女性34例,平均年龄(63.5±8.6)岁。按手术方法分为:体外循环组(on-pump coronary artery bypass grafting,CCABG)及非体外循环组(off-pump coronary artery bypass grafting,OPCAB)。CCABG组70例,共搭桥219支,乳内动脉(left internal mammary artery,LIMA)桥70支,大隐静脉(saphenous vein,SV)桥149支。OPCAB组62例,共搭桥181支,乳内动脉桥62支,大隐静脉桥119支。术中应用即时血流仪(transit-time flow meter,TTFM)测量桥血管血流量、搏动指数(pulsatility index,PI)及血流波形。 结果 两组患者术前一般资料差异无统计学意义。术中桥血流测量:乳内动脉-前降支桥血流量CCABG组为(27.3±16.5) ml/min,OPCAB组为(27.7±18.7) ml/min (P=0.812);两组PI值分别为3.1±1.6及3.0±1.8(P=0.312),差异均无统计学意义。大隐静脉-回旋支桥血流量CCABG组为(37.3±3.4) ml/min,OPCAB组为(35.0±5.6) ml/min (P=0.086);两组PI值分别为2.9±1.5及3.0±1.7(P=0.675),差异无统计学意义。 结论 对于左主干病变的患者,不论行CCABG或OPCAB,对桥血管及吻合口的质量无影响,均可达到满意的再血管化。

     

    Abstract: Objective To compare the effect of different surgical procedures on graft blood flow in patients with left main coronary artery lesion. Methods One hundred and thirty-two patients with left main coronary artery lesion(98 males and 34 females) aged 63.5±8.6 years,who underwent operation in our hospital from January 2010 to December 2011,were divided into extracorporeal coronary artery bypass grafting group(extracorporeal circulation group,n=70) and non-extracorporeal coronary artery bypass grafting group(non-extracorporeal circulation group,n=62).A total of 219 grafts were bypassed,including 70 grafts for left internal mammary artery(LIMA) and 149 grafts for saphenous vein(SV) in extracorporeal circulation group.A total of 181 grafts were bypassed in non-extracorporeal circulation group,including 62 for LIMA and 119 for SV.Intra-operative blood flow volume,pulsation index(PI),and blood flow waveform of the patients were measured with a transit-time flow meter. Results No significant difference was found in the general data between the two groups before operation.The mean blood flow in LIMA-descending anterior branch graft and the PI were(27.3±16.5)ml/min,(27.7±18.7)ml/min and 3.1±1.6,3.0±1.8,respectively,the mean blood flow in SV-circumflex artery branch graft and the PI were(37.3±3.4)ml/min,(35.0±5.6)ml/min(P=0.086) and 2.9±1.5,3.0±1.7(P=0.675),respectively,in extracorporeal circulation group and non-extracorporeal circulation group(P>0.05). Conclusion Both extracorporeal coronary artery bypass grafting and non-extracorporeal coronary artery bypass grafting have no effect on grafted blood vessels and anastomotic stoma in patients with left main coronary lesion.

     

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