Walpoth B H, Bosshard A, Genyk I, Kipfer B, Berdat P A, Hess O M, Althaus U, Carrel T P
Department of Thoracic and Cardiovascular Surgery, University Hospital, Berne, Switzerland.
Ann Thorac Surg. 1998 Sep;66(3):1097-100. doi: 10.1016/s0003-4975(98)00653-5.
A low-flow situation in arterial and venous grafts has been associated with high rates of perioperative infarction and mortality. This study was designed to look at intraoperative graft flow and resistance in patients with coronary artery disease.
Coronary artery bypass graft flow was measured in 46 patients. Transit-time flow was used for coronary flow measurements at rest as well as after maximal vasodilation with adenosine infusion.
Forty-three of the 46 patients showed normal internal mammary artery graft flow (>20 mL/min); 3 patients had no or minimal graft flow. Redoing the graft anastomosis in these 3 patients resulted in normalization of graft flow. The mean flow increased significantly after correction from 0.5 +/- 0.7 mL/min to 15.7 +/- 9.6 mL/min (p < 0.02). Conversely, vascular resistance decreased significantly from 138 +/- 10 to 4.8 +/- 1.8 Ohmv (p < 0.0001), as did the pulsatility index (from 146.9 +/- 95.7 to 3.4 +/- 1.8; p < 0.001). After correction, coronary flow reserve was 2.5 +/- 1.1.
Measurements of intraoperative flow and resistance as well as derived variables allow assessment of early graft function and thus help prevent graft failure and reduce perioperative infarction. Transit-time volume flow might be a simple tool for quality control in coronary bypass procedures.
动脉和静脉移植物的低流量情况与围手术期梗死和死亡率的高发生率相关。本研究旨在观察冠心病患者术中移植物的血流和阻力。
对46例患者的冠状动脉搭桥移植物血流进行了测量。采用通过时间血流法在静息状态下以及在输注腺苷进行最大血管扩张后测量冠状动脉血流。
46例患者中有43例显示乳内动脉移植物血流正常（>20毫升/分钟）；3例患者移植物血流无或极少。对这3例患者重新进行移植物吻合后，移植物血流恢复正常。校正后平均血流从0.5±0.7毫升/分钟显著增加至15.7±9.6毫升/分钟（p<0.02）。相反，血管阻力从138±10显著降至4.8±1.8欧姆伏（p<0.0001），搏动指数也显著降低（从146.9±95.7降至3.4±1.8；p<0.001）。校正后，冠状动脉血流储备为2.5±1.1。
术中血流和阻力以及派生变量的测量可评估早期移植物功能，从而有助于预防移植物失败并减少围手术期梗死。通过时间容积血流可能是冠状动脉搭桥手术质量控制的一个简单工具。
