术中即时桥血管流量测定在不停跳冠状动脉旁路移植术中的应用研究

目的:探讨术中即时血流测定(transit time flow measurement,TTFM)在不停跳冠状动脉旁路移植术中的应用价值。方法:2009年12月至2010年12月,对在北京安贞医院心外科行不停跳冠状动脉旁路移植术的427例患者,共计1 123支桥血管行术中即时血流测定,根据测定结果,定义满足以下3点标准中的2点者为桥血管失功能:1.搏动指数(PI)>5,2.左侧冠状动脉平均流量(mean graft flow,MGF)<10mL/min,右侧冠状动脉桥血管MGF<15mL/min,3.舒张期血流比例(diastolic flow,DF):左侧冠状动脉桥血管<50%,右侧冠状动脉桥血管<40%。对失功能的桥血管进行修正后再次测定血流量。结果:41例患者(41/427,9.6%)的47支桥血管(47/1 123,4.2%)诊断为失功能桥血管,修正的桥血管中13支为前降支桥血管,7支为对角支桥血管,15支为回旋支桥血管,11支为右侧冠状动脉桥血管。45支桥血管修正后流量满意,成功率为95.7%;2支桥血管修正后无明显改善。但术后6个月冠状动脉CTA检查示桥血管均通畅。结论:术中TTFM能便捷、有效地检测出由于吻合口狭窄导致的桥血管失功能,提高手术疗效,减少围术期不良心脏事件发生率。但对于冠状动脉远端血管床阻力较高的患者,其应用价值有待进一步观察。

Clinical application of transit time flow measurement in off-pump coronary artery bypass grafting

Objective:To assess the role of transit time flowmetry(TTFM) in off-pump coronary artery bypass grafting.Methods:From December 2009 to December 2010,427 patients underwent isolate primary off-pump coronary artery bypass grafting in cardiac surgery Beijing Anzhen hospital.1 123 grafs were measured by TTFM.According to the date,non-function grafts were defied as at least include two of the follows:1.PI>5,2.left coronary mean graft flow(MGF)<10mL/min,right coronary MGF<15mL/min,3.Diastolic Flow(DF)left coronary<50%,right coronary<40%.Non-function grafts were revised and measured by TTFM again.Results:47 grafts(47/1 123,4.2%) for 41 patients(41/427,9.6%)were revised.Among the revised grafts,there were 13grafts for LAD,7grafts for diagonal and branches,15grafts for circumflex and 11grafts for RCA.Of the 47grafts,45 grafts acquired satisfied revision(95.7%),2 grafts remain non-function but CTA show patent grafts in 6 months after the surgery.Conclusion:Transit-time flow measurement enables technical problems to be diagnosed accurately and simply,allowing prompt revision of grafts,improving surgical results and reducing perioperative cardiac event.But the clinical efficacy of TTFM for patients with high coronary resistance are still controversial.