左侧乳内动脉Y型桥OPCAB40例近期疗效观察.docVIP

左侧乳内动脉Y型桥OPCAB 40例近期疗效观察 　　作者：戴炳光,王新,王宁,李华英　　作者单位：江苏，苏州大学附属第一医院心胸外科　　2 山东，济南市第四人民医院心外科 　　【摘要】 目的 总结非体外循环下左侧乳内动脉及桡动脉Y型桥的冠状动脉旁路移植术的疗效及安全性。方法 2005年1月至2008年10月，40例冠状动脉粥样硬化性心脏病患者,采用左侧乳内动脉及桡动脉作为移植物。术中采用带蒂半骨骼化的方法分别取材左侧的乳内动脉和桡动脉,端侧吻合成Y型桥，在非体外循环下,应用序贯吻合的方法进行非体外循环下冠状动脉旁路移植术。利用Medi-stim Butterfly流量计进行桥血管流量测定,并记录血流量及搏动指数。结果 全组40例共行冠状动脉旁路血管移植109支,平均2.7支/例。桥血管流量测定均通畅,左乳内动脉干流量为(33±6)ml/min,搏动指数为2.2±0.5,桡动脉流量为(41±11)ml/min,搏动指数为1.9±0.6。40例中,术后3例诉手背桡侧感觉异常、麻木,围术期心肌梗死1例，胸腔积液2例，肺部感染1例，术中室颤1例，无脑部并发症,无胸骨、纵隔感染。随访1~38个月(平均11个月)无死亡病例。结论 非体外循环下仅用左侧乳内动脉及桡动脉Y型桥的冠状动脉旁路移植术是安全、有效的,可以实现全动脉化的完全心肌血运重建目的,又避免手术中对升主动脉的操作，近期效果满意。适应于升主动脉有钙化、乳内动脉正常且粗大(2 mm)的左主干或类似左主干病变，手术近期效果满意。 　　【关键词】 冠状动脉旁路移植术;非体外循环;乳内动脉;桡动脉;Y型桥;血流量;搏动指数 　　[Abstract] Objective To summarize the efficacy and security of off-pump Y-bridge coronary artery bypass grafting with left internal mammary artery and radial artery.Methods From January 2005 to October 2008,40 patients with coronary atherosclerotic heart disease underwent off-pump coronary artery bypass grafting with left internal mammary artery and radial artery.The semiskeletonization left internal mammary artery and radial artery with pedicles composed the Y graft by end-to-side anastomosis.Sequential anastomosis was conducted.Medi-stim Butterfly flowmeter was used to measure and record blood flow of graft vessel and pulsatility index(PI).Results Onehundred and nine grafts were conducted for 40 patients,2.7 on average per patient.All grafts were unobstructed,as indicated by recorded graft flow during operation.Flow and PI of left internal mammary artery are 33±6 ml/min and 2.2±0.5 respectively while those of radial artery are 41±11 ml/min and 1.9±0.6 respectively.During the period either before or after operation,perioperative myocardial infarction occurred in one case and pleural effussion occurred in two cases.During operation,ventricular fibrillation occurred in one case.After operation,one patient reported pulmonary infection，and three patients reported abnormal