原位左侧乳内动脉重建前降支血管术中瞬时血流参数对围术期不良事件的预测价值

张国栋; 秦俊超; 张显贵; 韩增强; 赵舟; 高卿; 刘晶; 陈彧

doi:10.13201/j.issn.1001-1439.2020.09.018

原位左侧乳内动脉重建前降支血管术中瞬时血流参数对围术期不良事件的预测价值

- 北京大学人民医院心脏外科(北京, 100044)

详细信息

通讯作者: 陈彧,E-mail:chenyudoctor@163.com

中图分类号: R541.4

收稿日期: 2020-06-27

The predictive value of parameters of transit-time flow measurement in left anterior descending artery for perioperative adverse events

- Department of Cardiac Surgery, People's Hospital, Beijing University, Beijing, 100044, China

More Information

Corresponding author: CHEN Yu, E-mail: chenyudoctor@163.com

Received Date: 27 June 2020

摘要

摘要: 目的:探讨原位左侧乳内动脉重建前降支术中瞬时血流(TTFM)指标,在右冠和回旋系统血流参数满意的3支病变患者中,对术后死亡和主要不良事件的预测价值。方法:回顾性分析2017年10月-2019年12月在本中心接受单纯初次传统正中切口的3支病变患者230例,均接受LIMA-LAD,且均满足右冠和回旋系统桥血管血流参数满意(PI<5,MGF>20 ml/min)。其中ON-PUMP 111例,OFF-PUMP 119例,分别按前降支PI与MGF满意与否分组,分别对比PI和MGF满意与否对术后死亡和主要并发症的影响。结果:对OFF-PUMP手术分析结果发现,LIMA-LAD桥血管PI>5组(5例)较PI≤5组(114例),术后死亡(20.0%∶0%,P=0.042)、术后IABP使用率(20.0%∶0%,P=0.042)及术后新发肾衰需CRRT治疗(40.0%∶0.9%,P=0.004)、术后重返手术室(40.0%∶1.8%,P=0.008)及术后二次插管(20.0%∶0%,P=0.042)发生率更高,复合终点事件有更高的趋势(50.0%∶8.8%,P=0.079)。OFF-PUMP手术前降支MGF不满意组(24例)较满意组(95例),术后重返手术室(12.5%∶1.1%,P=0.026)及术后复合终点事件(25.0%∶6.3%,P=0.015)发生率更高,围术期心肌梗死发生率有更高趋势(16.7%∶4.2%,P=0.051)。但单独ON-PUMP手术,按前降支PI和MGF分组,均未发现死亡和主要并发症方面有明显区别。结论:TTFM参数中PI和MGF在OFF-PUMP手术对围术期不良事件的预测价值更高。OFF-PUMP前降支桥血管PI>5发生术后死亡、术后需要IABP治疗、术后新发肾衰需CRRT治疗、术后二次插管率更高。前降支桥血管血流<20 ml/min发生术后重返手术室及术后复合终点事件发生率更高。但本研究未发现在ON-PUMP手术前降支血流和PI对不良事件的预测价值。
- 冠状动脉旁路移植术 /
- 术中瞬时血流测定 /
- 左侧胸廓内动脉 /
- 前降支 /
- 围术期不良事件
Abstract: Objective:To investigate the predictive value of parameters of transit time flow measurement(TTFM) in left anterior descending artery(LAD) reconstructed by left internal mammary artery(LIMA) for perioperative adverse events.Method:We analyzed a total of 230 patients with triple diseased vessels who underwent coronary artery bypass grafting(CABG) with LIMA-LAD.The TTFM parameters of all involved patients in right artery and left circumflex artery system were both satisfactory(PI<5,MGF>20 ml/min).Perioperative adverse events were compared according to the satisfied(PI<5,MGF>20 ml/min) LIMA-LAD and unsatisfied(PI<5,MGF>20 ml/min) LIMA-LAD.Result:In OFF-PUMP CABGs,more postoperative death were in abnormal PI group,compared with normal PI group,(20.0% vs 0%,P=0.042),the same as postoperative IABP use(20.0% vs 0%,P=0.042),postoperative new renal failure requiring CRRT(40.0% vs 0.9%,P=0.004),postoperative re-opening(40.0% vs 1.8%,P=0.008),and postoperative reintubation(20.0% vs 0%,P=0.042).In OFF-PUMP CABGs,compared with normal MGF group,more re-opening(12.5% vs 1.1%,P=0.026) and postoperative composite end point events rates(25.0% vs 6.3%,P=0.015) were in abnormal MGF group.However,there was no significant difference in death and major complications in two groups according both the PI and MGF in ON-PUMP CABGs.Conclusion:TTFM parameters have higher predictive value for perioperative adverse events in OFF-PUMP CABGs.In OFF-PUMP CABGs,the abnormal PI group has more death,postoperative IABP insertion,new renal failure and postoperative re-intubation.
- coronary artery bypass grafting /
- transit time flow measurement /
- left internal mammary artery /
- left anterior descending artery /
- perioperative adverse events

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