不停跳冠状动脉搭桥手术中血压对桥血流量的影响

发布时间：2019-01-21 11:24

【摘要】：目的:观察不停跳冠状动脉搭桥术中血压对桥血流量的影响,指导冠脉搭桥术中及术后血压的调节。方法:选择首都医科大学附属北京朝阳医院2016年8月-10月行不停跳冠状动脉搭桥手术患者31例,术前检查无明显手术禁忌,取左乳内动脉及大隐静脉备用作为移植桥血管,术中应用瞬时血流量测量仪(TTFM)、心电监护仪及心排仪等多次重复测量并记录患者各桥血管瞬时的收缩压、舒张压、肺动脉压、心输出量、中心静脉压、心率、心排量、搏动指数及桥血流量等指标。记录数据并采用观察法及差值法进行统计学分析。结果:舒张压:对前降支桥血流量影响(P=0.818,r2=0.669)、对右冠桥血流量影响(P=0.674,r2=0.469)、对回旋桥血流量影响(P=0.817,r2=0.669)均呈显著影响且具有统计学意义。收缩压:对前降支桥血流量影响(P=0.685,r2=0.469)、对右冠桥血流量影响(P=0.637,r2=0.417)、对回旋桥血流量影响(P=0.780,r2=0.610)具有统计学意义。但是收缩压对前降支桥血流量影响较小。这与血流量图像相符。但是与泊肃叶血流公式不相符原因可能与冠脉血流量除受上述因素影响外还受自身调节及心肌舒缩活动的影响。结论:血压尤其是舒张压对三大主支血管均呈显著影响;而收缩压对各个桥的血流量影响差异较大;掌握血压对桥血流量的影响规律,对提高冠脉搭桥手术术中质量、避免围手术期心肌梗死等并发症的发生、指导术后及远期血压调节有临床意义。
[Abstract]:Aim: to observe the effect of blood pressure on blood flow during coronary artery bypass grafting (CABG) and to guide the blood pressure regulation during and after coronary artery bypass grafting (CABG). Methods: Thirty-one patients underwent coronary artery bypass grafting in Beijing Chaoyang Hospital affiliated to Capital Medical University from August to October 2016. There were no obvious contraindications in preoperative examination. The left internal mammary artery and saphenous vein were taken as graft vessels. Transient blood flow monitor (TTFM),) and cardiac output instrument (TTFM),) were used to measure and record the transient systolic blood pressure, diastolic blood pressure, pulmonary artery pressure, cardiac output, central venous pressure, heart rate and cardiac output. Pulsatility index and bridge blood flow. The data were recorded and analyzed statistically by observation method and difference method. Results: diastolic blood pressure (DBP) had an effect on the blood flow of anterior descending branch bridge (P < 0. 818), right coronary artery bridge (P < 0. 674), right coronary artery bridge (P = 0. 674), circumflex blood flow (P = 0. 817, P = 0. 817). R _ 2 ~ (6. 669) was significant and statistically significant. Systolic blood pressure (SBP): the effect on the blood flow of the anterior descending branch bridge (P < 0. 685), the right coronal bridge (P = 0. 637) and the circumflex bridge (P = 0. 780) was statistically significant. But systolic blood pressure has little effect on the blood flow of anterior descending branch bridge. This is consistent with the blood flow image. However, the reasons for the inconsistency with Posule's blood flow formula may be related to the influence of coronary blood flow, including self-regulation and myocardial systolic and diastolic activity, in addition to the above factors. Conclusion: blood pressure, especially diastolic blood pressure, has a significant effect on the blood flow of the three major branches, while systolic blood pressure has a great effect on the blood flow of each bridge. Mastering the effect of blood pressure on graft blood flow, improving the quality of coronary artery bypass surgery, avoiding complications such as perioperative myocardial infarction, and guiding postoperative and long-term blood pressure regulation have clinical significance.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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