瞬时血流测定技术在非体外循环冠状动脉旁路移植术中的应用价值及影响预后相关因素分析
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摘要
目的探讨瞬时血流测定技术在非体外循环冠状动脉旁路移植术中的应用价值及影响预后的相关因素。方法从青海省心脑血管病专科医院2017年2月至2018年2月收治的冠状动脉手术患者中选取102例作为研究对象,根据术后是否发生围术期心肌梗死(myocardial infarction,MI),分为MI组22例和非MI组80例,并分析瞬时血流测定技术在术中的应用价值,并通过Logistic回归分析影响患者预后的相关因素。结果本组102例患者中共7例患者因围术期低心排血量综合征采用主动脉球囊反搏,8例患者围术期新发心房颤动,2例患者新发脑卒中,5例患者在围术期因应激性溃疡新发上消化道出血。MI组主动脉球囊反搏患者比例略高于非MI组,差异有统计学意义(P<0.05);两组其余资料比较,差异无统计学意义(P>0.05)。MI组移植血管数量、左乳内动脉-左前降支血流量与非MI组比较,差异无统计学意义(P>0.05);MI组移植血管总血流量低于非MI组,差异有统计学意义(P<0.05);MI组与非MI组病死率比较,差异无统计学意义(4.55%vs. 1.25%,P>0.05)。受试者工作特征曲线(receiver operating characteristic curve,ROC)及Logistic回归分析结果均显示,移植血管总血流量是预测非体外循环冠状动脉旁路移植围术期MI事件的有效指标。结论采用瞬时血流测定技术测定术中移植血管总血流量,可作为预测非体外循环冠状动脉旁路移植围术期MI事件发生的有效指标。
ObjectivesTo investigate the application value of transit time flow meter(TTFM)in off-pump coronary artery bypass grafting(CABG)and the related factors that affect the prognosis.MethodsTotally 102 patients underwent coronary artery surgery in Qinghai Province Cardiovascular and Cerebrovascular Disease Special Hospital from February 2017 to February 2018 were selected as the subjects,according to whether the perioperative myocardial infarction(MI)occurred in the perioperative period,they were divided into MI group(n=20)and non MI group(n=80). Application value of TTFM in operation was analyzed. Logistic regression analysis was used to analyze the factors related to the prognosis of patients.ResultsIn 102 patients of the group,7 patients were implemented aortic balloon counterpulsation because of the low heart displacement syndrome during the perioperative period,8 patients had a new atrial fibrillation during the perioperative period,2 patients had a new stroke,5 patients had a new upper gastrointestinal bleeding due to stress ulcers during the perioperative period. Percentage of patients with the aortic balloon counterpulsation in MI group was slightly higher than that in non MI group(P<0.05),there was no statistically significant difference between the two groups(P>0.05);there was no significant difference in the number of transplanted vessels and left internal mammary artery-left anterior descending artery blood flow between MI group and non MI group(P>0.05);the total blood flow of blood vessel in MI group was lower than that in non MI group(P<0.05);there was no statistically significant difference between the mortality rate of MI group(4.55%)and the mortality rate of non MI group(4.55%)(P>0.05). Receiver operating characteristic curve and Logistic regression analysis showed that the total blood flow of blood vessel was an effective index to predict the MI event during the period of off-pump coronary artery bypass grafting.ConclusionsThe determination of the total blood flow of blood vessels during the operation by TTFM can be used as an effective indicator for predicting the occurrence of MI events at the perioperative period of off-pump coronary artery bypass grafting.
ObjectivesTo investigate the application value of transit time flow meter(TTFM)in off-pump coronary artery bypass grafting(CABG)and the related factors that affect the prognosis.MethodsTotally 102 patients underwent coronary artery surgery in Qinghai Province Cardiovascular and Cerebrovascular Disease Special Hospital from February 2017 to February 2018 were selected as the subjects,according to whether the perioperative myocardial infarction(MI)occurred in the perioperative period,they were divided into MI group(n=20)and non MI group(n=80). Application value of TTFM in operation was analyzed. Logistic regression analysis was used to analyze the factors related to the prognosis of patients.ResultsIn 102 patients of the group,7 patients were implemented aortic balloon counterpulsation because of the low heart displacement syndrome during the perioperative period,8 patients had a new atrial fibrillation during the perioperative period,2 patients had a new stroke,5 patients had a new upper gastrointestinal bleeding due to stress ulcers during the perioperative period. Percentage of patients with the aortic balloon counterpulsation in MI group was slightly higher than that in non MI group(P<0.05),there was no statistically significant difference between the two groups(P>0.05);there was no significant difference in the number of transplanted vessels and left internal mammary artery-left anterior descending artery blood flow between MI group and non MI group(P>0.05);the total blood flow of blood vessel in MI group was lower than that in non MI group(P<0.05);there was no statistically significant difference between the mortality rate of MI group(4.55%)and the mortality rate of non MI group(4.55%)(P>0.05). Receiver operating characteristic curve and Logistic regression analysis showed that the total blood flow of blood vessel was an effective index to predict the MI event during the period of off-pump coronary artery bypass grafting.ConclusionsThe determination of the total blood flow of blood vessels during the operation by TTFM can be used as an effective indicator for predicting the occurrence of MI events at the perioperative period of off-pump coronary artery bypass grafting.
引文
[1]吴明营,周自强.冠状动脉旁路移植术[J].中华保健医学杂志,2017,19(3):187-191.
[2]刘胜中,谭今,向波,等.非体外循环冠状动脉旁路移植术治疗冠心病的疗效分析[J].实用医院临床杂志,2016,13(1):19-25.
[3] THYGESEN K,ALPERT J S,WHITE H D. Universal definition of myocardial infarction[J]. J Am Coll Cardiol,2008,28(20):2525.
[4]刘胜中,谭今,于涛,等.非体外循环冠状动脉旁路移植术治疗高危冠心病的疗效评价[J].重庆医学,2017,46(10):1323-1325.
[5]刘慧敏,陈榕,孟庆涛,等.高危患者行非体外循环与体外循环冠状动脉旁路移植术效果及安全性的Meta分析[J].热带医学杂志,2017,17(6):755-760.
[6]安康,梅举,汤敏,等.乳内动脉-大隐静脉Y型复合桥血管的术中即时血流量测定及中期通畅率随访[J].中国心血管病研究,2017,15(5):413-417.
[7] GIAMMARCO G D,PANO M,CIRMENI S,et al. Predictive value of intraoperative transit-time flow measurement for shortterm graft patency in coronary surgery[J]. J Thorac Cardiovasc Surg,2006,132(3):468.
[8]周朝元,付庆林,牛珊珊,等.冠状动脉旁路移植术治疗ST段抬高心肌梗死的时机选择及术后死亡危险因素分析[J].广西医学,2016,38(2):189-193.
[9] KOZOWER B D,MOON M R,BARNER H B,et al. Impact of complete revascularization on long-term survival after coronary artery bypass grafting in octogenarians[J]. Ann Thorac Surg,2005,80(1):112-116.
[10]蒋钦,向波,于涛,等.非体外循环冠脉旁路移植术不完全再血管化的病例特点[J].实用医院临床杂志,2016,13(5):58-60.
[11]董士勇,李一帆,宋波,等.非体外循环冠状动脉旁路移植术围术期心肌梗死发生率与移植血管血流量的关系[J].中国胸心血管外科临床杂志,2011,18(6):498-502.
[12] KIESER T M,ROSE S,KOWALEWSKI R,et al. Transittime flow predicts outcomes in coronary artery bypass graft patients:a series of 1000 consecutive arterial grafts[J]. Eur J Cardiothorac Surg,2010,38(2):155-162.
[13]韩增强,陈彧,凌云鹏,等.左胸小切口与胸骨正中切口非体外冠状动脉旁路移植术中左乳内动脉桥血流对比分析[J].中国循环杂志,2016,31(10):981-983.
[14] GURNéO,CHENU P,BUCHE M,et al. Adaptive mechanisms of arterial and venous coronary bypass grafts to an increase in flow demand[J]. Heart,1999,82(3):336.
[2]刘胜中,谭今,向波,等.非体外循环冠状动脉旁路移植术治疗冠心病的疗效分析[J].实用医院临床杂志,2016,13(1):19-25.
[3] THYGESEN K,ALPERT J S,WHITE H D. Universal definition of myocardial infarction[J]. J Am Coll Cardiol,2008,28(20):2525.
[4]刘胜中,谭今,于涛,等.非体外循环冠状动脉旁路移植术治疗高危冠心病的疗效评价[J].重庆医学,2017,46(10):1323-1325.
[5]刘慧敏,陈榕,孟庆涛,等.高危患者行非体外循环与体外循环冠状动脉旁路移植术效果及安全性的Meta分析[J].热带医学杂志,2017,17(6):755-760.
[6]安康,梅举,汤敏,等.乳内动脉-大隐静脉Y型复合桥血管的术中即时血流量测定及中期通畅率随访[J].中国心血管病研究,2017,15(5):413-417.
[7] GIAMMARCO G D,PANO M,CIRMENI S,et al. Predictive value of intraoperative transit-time flow measurement for shortterm graft patency in coronary surgery[J]. J Thorac Cardiovasc Surg,2006,132(3):468.
[8]周朝元,付庆林,牛珊珊,等.冠状动脉旁路移植术治疗ST段抬高心肌梗死的时机选择及术后死亡危险因素分析[J].广西医学,2016,38(2):189-193.
[9] KOZOWER B D,MOON M R,BARNER H B,et al. Impact of complete revascularization on long-term survival after coronary artery bypass grafting in octogenarians[J]. Ann Thorac Surg,2005,80(1):112-116.
[10]蒋钦,向波,于涛,等.非体外循环冠脉旁路移植术不完全再血管化的病例特点[J].实用医院临床杂志,2016,13(5):58-60.
[11]董士勇,李一帆,宋波,等.非体外循环冠状动脉旁路移植术围术期心肌梗死发生率与移植血管血流量的关系[J].中国胸心血管外科临床杂志,2011,18(6):498-502.
[12] KIESER T M,ROSE S,KOWALEWSKI R,et al. Transittime flow predicts outcomes in coronary artery bypass graft patients:a series of 1000 consecutive arterial grafts[J]. Eur J Cardiothorac Surg,2010,38(2):155-162.
[13]韩增强,陈彧,凌云鹏,等.左胸小切口与胸骨正中切口非体外冠状动脉旁路移植术中左乳内动脉桥血流对比分析[J].中国循环杂志,2016,31(10):981-983.
[14] GURNéO,CHENU P,BUCHE M,et al. Adaptive mechanisms of arterial and venous coronary bypass grafts to an increase in flow demand[J]. Heart,1999,82(3):336.