Kamiya Hiroyuki, Akhyari Payam, Martens Andreas, Karck Matthias, Haverich Axel, Lichtenberg Artur
Department of Cardiovascular Surgery, University of Heidelberg, Heidelberg, Germany.
J Thorac Cardiovasc Surg. 2008 Jan;135(1):32-7. doi: 10.1016/j.jtcvs.2007.09.004.
In human patients the influence of skeletonized internal thoracic artery harvesting on the sternal microcirculation in the perioperative phase has not been well investigated.
Twenty-four consecutive male patients who were scheduled for isolated coronary artery bypass grafting were prospectively randomized into 2 groups. The left internal thoracic artery was harvested by using the skeletonized technique in group 1, and it was harvested with a pedicle in group 2. Superficial (2 mm) and deep (8 mm) tissue oxygen saturation and blood flow were measured presternally and retrosternally in the upper, middle, and lower sternal parts with a novel laser Doppler flowmetric and remission spectroscopic system (Oxygen-to-See; LEA Medizintechnik, Giessen, Germany).
Presternal tissue oxygen saturation deteriorated at the upper and middle sternum, and presternal blood flow deteriorated at all measurement points after internal thoracic artery harvesting in both groups. Skeletonization had no advantage in maintaining presternal microcirculation. Retrosternal microcirculation also deteriorated at all measurement points after internal thoracic artery harvesting in both groups. However, the deterioration of the retrosternal microcirculation was significantly less in group 1 at the middle and lower sternum; values of oxygen saturation to the baseline were 86% +/- 3.8% versus 60% +/- 4.3% (P = .001) at 2-mm depth and 82% +/- 4.2% versus 61% +/- 6.1% (P = .009) at 8-mm depth at the middle sternum and 95% +/- 3.2% versus 78% +/- 1.3% (P = .001) at 2-mm depth and 94% +/- 2.2% versus 78% +/- 4.6% (P = .004) at 8-mm depth at the lower sternum in groups 1 and 2, respectively.
The damage of the tissue microcirculation in the middle and lower retrosternal area is significantly less after internal thoracic artery skeletonization compared with that after the pedicled internal thoracic artery harvesting technique.
在人类患者中，围手术期骨骼化胸廓内动脉获取对胸骨微循环的影响尚未得到充分研究。
将24例连续计划进行单纯冠状动脉旁路移植术的男性患者前瞻性随机分为2组。第1组采用骨骼化技术获取左胸廓内动脉，第2组带蒂获取。使用新型激光多普勒血流仪和反射光谱系统（Oxygen-to-See；德国吉森LEA Medizintechnik公司）在前胸壁和胸骨后上、中、下胸骨部分测量浅表（2毫米）和深部（8毫米）组织氧饱和度及血流。
两组胸廓内动脉获取后，前胸壁上、中胸骨处组织氧饱和度下降，前胸壁所有测量点血流均下降。骨骼化在维持前胸壁微循环方面无优势。两组胸廓内动脉获取后，胸骨后所有测量点微循环也均下降。然而，第1组胸骨中、下部位胸骨后微循环的下降明显较少；在胸骨中部，2毫米深度处氧饱和度相对于基线值分别为86%±3.8%和60%±4.3%（P = 0.001），8毫米深度处为82%±4.2%和61%±6.1%（P = 0.009）；在胸骨下部，2毫米深度处氧饱和度相对于基线值分别为95%±3.2%和78%±1.3%（P = 0.001），8毫米深度处为94%±2.2%和78%±4.6%（P = 0.004）。
与带蒂胸廓内动脉获取技术相比，胸廓内动脉骨骼化后胸骨后中、下区域组织微循环的损伤明显较小。
