Duda A M, Letwin L B, Sutter F P, Goldman S M
Department of Anesthesiology, Lankenau Hospital and Medical Research Center, Wynnewood, PA.
J Vasc Surg. 1995 Jan;21(1):98-107; discussion 108-9. doi: 10.1016/s0741-5214(95)70248-2.
The purpose of this study is to determine whether the routine use of intraoperative surface aortic ultrasonography decreases the stroke rate in coronary artery bypass graft surgery (CABG).
One hundred ninety-five consecutive patients undergoing CABG between July 1, 1992, and June 30, 1993 (study group), were evaluated by intraoperative surface aortic ultrasonography. Based on information obtained, changes in the operative technique were made in an effort to decrease the incidence of embolic stroke from unsuspected atherosclerotic disease of the ascending aorta. The outcome of these patients was compared with that of 164 consecutive patients who underwent CABG between July 1, 1991, and June 30, 1992 (control group), in whom the ascending aorta was assessed by inspection and palpation only.
Significant disease was detected in three (2.0%) of 164 patients in the control group. Modifications in their operative technique consisted of hypothermic fibrillatory arrest with no cross-clamping of the aorta and left ventricular venting in two patients and single cross-clamping in one patient. There were five strokes overall in this group (3.0%), and six patients died (3.6%), one in whom the stroke contributed directly to the cause of death. In the study group the ultrasonic findings were normal to mild in 168 patients, moderate in 20 patients, and severe in seven patients. These results led to a modification of the technique in 19 patients, (10%): hypothermic fibrillatory arrest with no cross-clamping of the aorta and left ventricular venting in 14 patients, modification in the aortic cannulation site or single cross-clamping in three patients, and modification in placement of proximal anastomoses or all arterial grafts in two patients. No strokes occurred in this group (p < 0.02, Fisher's exact test). Five patients died, for an operative mortality rate of 2.6%.
These data indicate that intraoperative ultrasonography of the ascending aorta with simple modifications in operative technique reduces the stroke rate in CABG.
本研究旨在确定术中常规使用体表主动脉超声检查是否能降低冠状动脉搭桥手术（CABG）中的卒中发生率。
对1992年7月1日至1993年6月30日期间连续接受CABG的195例患者（研究组）进行术中体表主动脉超声检查。根据所获得的信息，对手术技术进行调整，以降低升主动脉未被怀疑的动脉粥样硬化疾病导致的栓塞性卒中发生率。将这些患者的结果与1991年7月1日至1992年6月30日期间连续接受CABG的164例患者（对照组）的结果进行比较，对照组仅通过检查和触诊评估升主动脉。
对照组164例患者中有3例（2.0%）检测到严重病变。他们手术技术的调整包括2例患者采用低温颤动停搏、不进行主动脉交叉钳夹和左心室排气，1例患者采用单次交叉钳夹。该组总共发生5例卒中（3.0%），6例患者死亡（3.6%），其中1例卒中直接导致死亡。在研究组中，168例患者的超声检查结果正常至轻度，20例患者为中度，7例患者为重度。这些结果导致19例患者（10%）的技术调整：14例患者采用低温颤动停搏、不进行主动脉交叉钳夹和左心室排气，3例患者调整主动脉插管部位或采用单次交叉钳夹，2例患者调整近端吻合口或所有动脉移植物的放置。该组未发生卒中（p<0.02，Fisher精确检验）。5例患者死亡，手术死亡率为2.6%。
这些数据表明，术中对升主动脉进行超声检查并对手术技术进行简单调整可降低CABG中的卒中发生率。
