2023 年第 5 期 第 18 卷

术中瞬时血流测定对冠状动脉旁路移植术后桥血管质量的预测价值

The predictive value of intraoperative transit-time flow measurement on the quality of bridging vessels after coronary artery bypass grafting

作者：贾彦雄高杰顾松刘岩张希涛安向光苏丕雄

英文作者：Jia Yanxiong Gao Jie Gu Song Liu Yan Zhang Xitao An Xiangguang Su Pixiong

单位：首都医科大学附属北京朝阳医院心脏中心高血压病研究北京市重点实验室，北京100020

英文单位：Heart Center and Beijing Key Laboratory of Hypertension Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China

关键词：冠状动脉旁路移植术；术中瞬时血流测定；桥血管通畅率；主要不良心脑血管事件

英文关键词：Coronaryarterybypassgrafting;Transit-timeflowmeasurement;Patencyrateofbridgingvessel;Majoradversecardio-cerebralvascularevents

• 摘要：

• 目的 探究术中瞬时血流测定（TTFM）对于评价冠状动脉旁路移植术(CABG)后桥血管通畅率和主要不良心脑血管事件（MACCE）的可行性及价值。方法 对2015年1月至2017年12月于首都医科大学附属北京朝阳医院行CABG的114例患者进行术后CT冠状动脉造影及MACCE随访。根据桥血管狭窄程度分为正常组（桥血管无狭窄或桥血管与吻合口狭窄≤50%）和病变组（桥血管或吻合口狭窄>50%及桥血管完全闭塞）。结合术中TTFM数据，采用Logistic回归方法分析桥血管病变和MACCE的危险因素，采用受试者工作特征（ROC）曲线评价TTFM参数对桥血管质量的预测价值。结果  114例患者共移植桥血管320支，其中左侧乳内动脉（LIMA）113支，术后通畅率为89.4%（101/113），大隐静脉207支，术后通畅率为75.4%（156/207）。MACCE合计发生17例，发生率为14.9%（17/114）。不同桥血管狭窄程度组比较结果显示病变组平均血流量（MGF）低于正常组，术后新发心房颤动的比例高于正常组［18.20（10.95，23.90）ml/min比19.00（13.93，30.13）ml/min、12.4%（14/113）比5.8%（12/207）］，差异均有统计学意义（均P<0.05）。以桥血管病变和MACCE作为结局变量进行Logistic回归分析，结果显示较低的MGF是桥血管病变的独立危险因素（比值比=0.98，P=0.021）；LIMA及大隐静脉分组分析中发现MGF是大隐静脉病变的独立危险因素（比值比=0.97，P=0.014）。MGF对桥血管病变有预测价值（P=0.011）。结论   TTFM对于CABG术后桥血管通畅率有预测价值，但无法高效预测MACCE的发生。

• Objective  To explore the feasibility and value of intraoperative transit-time flow measurement (TTFM) for evaluating the patency rate of bridging vessels and the major adverse cardio-cerebral vascular events (MACCE) after coronary artery bypass grafting(CABG). Methods From January 2015 to December 2017, 114 patients who underwent CABG in Beijing Chao-Yang Hospital, Capital Medical University were followed-up postoperatively with CT coronary angiography and MACCE. According to the degree of stenosis of the bridging vessel, they were divided into normal group (no stenosis or the stenosis of the bridging vessel and anastomotic orifice ≤ 50%) and the lesion group (stenosis of the bridging vessel or anastomotic orifice > 50% and complete occlusion of the bridging vessel). Combined with the intraoperative TTFM data, Logistic regression method was used to analyze the risk factors of bridging vascular lesions and MACCE, and the receiver operating characteristic(ROC) curve was used to evaluate the predictive value of TTFM parameters on the quality of bridging vessels. ResultsA total of 320 bridging vessels were transplanted in 114 patients. Among them, 113 left internal mammary arteries (LIMA) had a postoperative patency rate of 89.4% (101/113), and 207 great saphenous veins had a postoperative patency rate of 75.4% (156/207). MACCE occurred in 17 cases, with an incidence of 14.9%(17/114). The comparison results of different bridging stenosis groups showed that the mean graft flow (MGF) in the lesion group was lower than that in the normal group, and the proportion of new atrial fibrillation after surgery was higher than that in the normal group［18.20(10.95, 23.90)ml/min vs 19.00(13.93, 30.13)ml/min, 12.4%(14/113) vs 5.8%(12/207)］(both P<0.05). Logistic regression analysis was performed with bridging vascular lesion and MACCE as outcome variables. The results showed that lower MGF was an independent risk factor for bridging vascular lesion(odds ratio=0.98, P=0.021). MGF was found to be an independent risk factor for great saphenous vein lesions in LIMA and great saphenous vein grouping analysis (odds ratio=0.97, P=0.014). MGF had predictive value for bridging vascular lesion(P=0.011). Conclusion TTFM has predictive value for the patency rate of bridging vessel after CABG, but cannot efficiently predict the occurrence of MACCE.