冠状动脉闭塞对右冠状动脉及左前降支冠状动脉旁路移植术后桥血流的影响

摘要

Objective To study the effects of coronary occlusion on blood flows of grafts in patients with right coronary and left anterior descending (LAD) coronary artery bypass grafting (CABGs).Methods Two-hundred and twelve patients with CABGs were sellected from May 2015 to May 2016,48 patients with occlusion of right coronary and 74 patients without occlusion of right coronary,50 patients with occlusion of left anterior descending and 162 patients without occlusion of left anterior descending were involved in this study.Transit-time flowmeter(TTFM) was utilized to measure and record the blood flows of grafts,pulsatility index (PI) and diastolic flow (DF).Results The mean blood flows of grafts in patients with or without occlusion of right coronary were (25.81 ± 19.44) and (30.82 ± 23.98) ml/min respectively,and the values of PI were 3.26 ± 2.50 and 2.74 ± 4.17,there were no significant differences between the two groups(P =0.228,P =0.441).The mean blood flows of grafts in patients with or without occlusion of LAD were (33.21 ±30.81) and (24.70 ±20.45)ml/rnin respectively,and the values of PI were 2.62 ± 1.31 and 2.93 ± 3.31,there was no significant difference between the two groups (P =0.067,P =0.441).The percentage of DF in patients with occlusion of right coronary [(61.97 ± 10.61) ％] was significant lower than patients without occlusion of right coronary [(66.86 ± 7.85) ％,P =0.004],however,there was no significant difference between patients with [(73.34 ± 10.21)％] and without [(75.39 ±8.09)％] occlusion of LAD (P =0.143).Conclusions There are no effects of coronary occlusion on blood flows of grafts in patients with right coronary and left anterior descending CABGs,and CABGs is an optimal measure for these two kinds of patients.%目的 探讨冠状动脉闭塞对右冠状动脉及左前降支冠状动脉旁路移植术(CABG)后桥血流量的影响.方法 收集2015年5月至2016年5月行冠状动脉旁路移植术的住院患者212例,其中右冠状动脉闭塞患者48例,右冠状动脉未闭塞患者74例,左前降支闭塞患者50例,左前降支未闭塞患者162例,术中使用即时血流测量仪(TTFM)直接测量并记录右冠状动脉及左前降支桥血管的平均血流量(MF)、搏动指数(PI)、舒张期血供比例(DF).结果 48例右冠状动脉闭塞患者和74例未闭塞患者的平均血流量分别为(25.81±19.44)、(30.82±23.98) ml/min,PI分别为3.26±2.50、2.74±4.17,二者比较差异未见统计学意义(P =0.228,P=0.441).50例左前降支闭塞患者和162例未闭塞患者的平均血流量分别为(33.21±30.81)、(24.70±20.45) ml/min,PI分别为2.62±1.31、2.93±3.31,二者比较差异未见统计学意义(P =0.067,P=0.441).右冠状动脉闭塞患者DF[(61.97±10.61)％]明显低于右冠状动脉未闭塞患者[(66.86±7.85)％],差异有统计学意义(P=0.004);但左前降支闭塞患者DF[(73.34±10.21)％]与左前降支未闭塞患者[(75.39±8.09)％]比较差异未见统计学意义(P=0.143).结论 右冠状动脉闭塞或左前降支闭塞不影响患者行CABG后桥血流量,CABG能够有效治疗这两类患者.