Rolla G, Fogliati P, Bucca C, Brussino L, Di Rosa E, Di Summa M, Comoglio C, Malara D, Ottino G M
Department of Scienze Biomediche, University of Torino, Italy.
Respir Med. 1994 Jul;88(6):417-20. doi: 10.1016/s0954-6111(05)80043-5.
Coronary artery by-pass grafting with internal mammary artery (IMA) has become the graft conduit of choice, due to improved survival and its long term patency rate. However, some studies have shown that, in comparison with saphenous vein grafts, after IMA grafting, there is increased postoperative impairment of pulmonary function, possibly due to the frequent performance of pleurotomy. In 57 consecutive patients, admitted for elective CABG with IMA, we prospectively evaluated the early (2nd and 6th day) postoperative chest X-ray complications and the late (2 months) respiratory function tests changes. Thirty-two patients had been subjected to pleurotomy (group 1) and 25 not (group 2). The incidence of pulmonary atelectasis and pleural effusion in 2nd and in 6th postoperative days was not different in the two groups: 22 vs. 19%, 74 vs. 52% in 2nd, and 29 vs. 19%, 48 vs. 38% in 6th postoperative day respectively. The incidence of elevated hemidiaphragm in 6th postoperative day was not different in the two groups (18.5 vs. 14%). Two months after surgery the mean values of spirometric tests were significantly lower than the preoperative values: VC from 88.5 +/- 1.26 to 80 +/- 1.65% of predicted, P < 0.001, FEV1 from 96.1 +/- 1.27 to 84.7 +/- 1.73% of predicted, P < 0.001, MEF50 from 84.9 +/- 3.14 to 69.2 +/- 3.18% of predicted, P < 0.001. No significant changes were detected in RV and in AaPO2.(ABSTRACT TRUNCATED AT 250 WORDS)
由于能提高生存率及其长期通畅率，使用乳内动脉（IMA）进行冠状动脉旁路移植术已成为首选的移植管道。然而，一些研究表明，与大隐静脉移植相比，IMA移植后肺功能的术后损害有所增加，这可能是由于频繁进行胸膜切开术所致。在连续57例因择期IMA冠状动脉旁路移植术入院的患者中，我们前瞻性地评估了术后早期（第2天和第6天）胸部X线并发症以及晚期（2个月）呼吸功能测试的变化。32例患者接受了胸膜切开术（第1组），25例未接受（第2组）。两组术后第2天和第6天肺不张和胸腔积液的发生率无差异：术后第2天分别为22%对19%，74%对52%；术后第6天分别为29%对19%，48%对38%。两组术后第6天半侧膈肌抬高的发生率无差异（18.5%对14%）。术后两个月，肺量计测试的平均值显著低于术前值：肺活量从预测值的88.5±1.26%降至80±1.65%，P<0.001；第1秒用力呼气量从预测值的96.1±1.27%降至84.7±1.73%，P<0.001；最大呼气中期流速从预测值的84.9±3.14%降至69.2±3.18%，P<0.001。右心室和肺泡动脉氧分压差未发现显著变化。（摘要截断于250字）
