左乳内动脉左前降支冠脉旁路移植桥血流量影响因素分析

发布时间：2019-02-21 17:57

【摘要】：目的探讨冠脉旁路移植术(Coronary artery bypass grafting,CABG)术中左前降支(Left anterior descending,LAD)靶血管闭塞与未闭塞对桥血管血流量的影响。研究CABG术中左乳内动脉(Left internal mammary artery,LIMA)—LAD桥血管流量高低的影响因素。方法收集2015年10月至2016年7月间行非体外循环下冠脉旁路移植术的住院患者212例,其中左前降支闭塞患者50例、左前降支未闭塞患者162例,左前降支分为靶血管闭塞与未闭塞两组,术中使用瞬时血流测量(Transit time flowmeter,TTFM)直接测量并记录左前降支桥血管的桥血流参数平均血流(Mean graft flow,MGF)、搏动指数(pulsatility index,PI)、舒张期血流比例(Diastolic filling,DF)。比较左前降支闭塞与未闭塞病人桥血流量。同时记录患者有无心肌梗死、冠脉狭窄程度、靶血管直径、性别、年龄、体重、有无高血压等因素。未闭塞组162例患者按MGF22 mL/min为高流量桥、MGF22mL/min为低流量的标准把桥血流量分为高低2组,分析以上所有因素对左前降支未闭塞LIMA——LAD桥血管高流量低的影响。结果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)和(24.70±20.45)mL/min,PI分别为(2.62±1.31)和(2.93±3.31),左前降支闭塞患者与未闭塞患者的平均血流量和PI无显著性差异(p=0.067,p=0.441);左前降支闭塞患者的DF(73.34±10.21)与左前降支未闭塞患者(75.39±8.09)(p=0.143)无显著性差异。对左前降支未闭塞组LIMA—LAD桥血流量高低的影响因素进行Logistic回归分析结果显示有心肌梗死LIMA桥平均血流量高(p=0.005)。DF高桥平均血流量高(p=0.001)。冠脉狭窄程度重桥平均血流量高(p=0.037)。结论1.左前降支闭塞闭塞不影响LIMA—LAD桥血流量。2.无心肌梗死、DF低、狭窄程度低是LIMA-LAD桥血流量低的危险因素。
[Abstract]:Objective to investigate the effect of left anterior descending branch (Left anterior descending,LAD) target vessel occlusion and non-occlusion on the blood flow of the graft during coronary artery bypass grafting (Coronary artery bypass grafting,CABG). To study the influencing factors of left intramammary artery (Left internal mammary artery,LIMA)-LAD graft flow during CABG. Methods from October 2015 to July 2016, 212 patients underwent off-pump coronary artery bypass grafting, including 50 patients with left anterior descending branch occlusion and 162 patients with left anterior descending artery occlusion. The left anterior descending branch was divided into two groups: the target vessel occlusion group and the non-occlusion group. The mean blood flow parameters (Mean graft flow,MGF) and pulsatile index (pulsatility index,) of the left anterior descending artery were measured and recorded directly by transient blood flow measurement (Transit time flowmeter,TTFM). PI), diastolic blood flow ratio (Diastolic filling,DF). To compare the blood flow between left anterior descending artery occlusion and unoccluded patients. Factors such as myocardial infarction, coronary stenosis, target vessel diameter, sex, age, weight and hypertension were also recorded. According to the criteria of MGF22 mL/min as high flow bridge and MGF22mL/min as low flow rate, 162 patients in non-occluded group were divided into two groups. The influence of all the above factors on the high flow and low flow of left anterior descending branch LIMA--LAD graft was analyzed. Results the mean blood flow of 50 patients with left anterior descending branch occlusion and 162 patients with no occlusion were (33.21 卤30.81) and (24.70 卤20.45) mL/min,PI, respectively (2.62 卤1.31) and (2.93 卤3.31). There was no significant difference in the mean blood flow and PI between the patients with left anterior descending branch occlusion and those without occlusion (p0. 067 and p0. 441). There was no significant difference in DF between the patients with left anterior descending branch occlusion (73.34 卤10.21) and the patients without left anterior descending branch occlusion (75.39 卤8.09) (p = 0.143). The results of Logistic regression analysis showed that the mean blood flow of LIMA-LAD bridge was high in patients with myocardial infarction (p0. 005). DF high bridge) (p0. 001). The mean blood flow of severe coronary artery stenosis was higher (p < 0. 037). Conclusion 1. Left anterior descending artery occlusion did not affect the blood flow of LIMA-LAD bridge. 2. No myocardial infarction, low DF and low degree of stenosis were the risk factors for low blood flow of LIMA-LAD bridge.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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