摘要
目的观察冠状动脉血流储备分数(FFR)与术中旁路移植血管血流模式状态的关系,探讨FFR在冠状动脉旁路移植手术中的指导作用。方法回顾性纳入2016年3月至2019年10月,86例冠状动脉旁路移植患者,其中男59例,女27例;年龄42~77岁,平均(58±12)岁。术前评估左前降支动脉的FFR值,根据术前FFR值将患者分为重度缺血组(FFR<0.75)、临界组(0.75≤FFR<0.80)和轻度缺血组(FFR≥0.80)。术中使用瞬时流量测定仪评估胸廓内动脉至左前降支动脉的旁路移植血管血流状态。结果重度缺血组、临界组和轻度缺血组患者的移植血管平均血流量分别为(21.24±5.71)ml/min、(18.25±7.72)ml/min和(16.47±7.83)ml/min,搏动指数分别为2.58±0.96、3.14±1.19和3.53±1.34,舒张期充盈比例分别为0.63±0.10、0.55±0.11和0.53±0.11,出现收缩期逆流患者分别为2例(3.6%)、3例(18.8%)、3例(20.0%)。三组间的移植血管流量(P=0.027)、搏动指数(P=0.007)、舒张期充盈比例(P=0.001)和出现收缩期逆流患者比例(P=0.027)差异均有统计学意义。结论随着冠状动脉狭窄严重程度增加,旁路移植血管流量增加,搏动指数减少,舒张期充盈比例有所上升,收缩期逆流的患者比例有减少趋势。对于轻中度功能性冠状动脉狭窄(FFR≥0.75)的患者,近中期及血管闭塞机会可能增加;对于重度狭窄(FFR<0.75)患者而言,能获得较满意流量参数及可能的较好临床效果。
Objective To investigate the potential guiding role of fractional flow reserve(FFR)in surgical revascularization by comparing the relationship between coronary fractional flow reserve(FFR)and blood flow pattern status of bypass graft.Methods A total of 86 patients with coronary artery disease between March 2016 to October 2019 were included in the study,with 59 males and 27 females;the age ranged from 42 to 77 years old,with an average of(58±12)years old.According to the measured FFR value of the left anterior descending artery,they were divided into severe ischemic group(FFR<0.75),boundary group(0.75≤FFR<0.80)and mild ischemic group(FFR≥0.80).Transit time flow meter(TTFM)was used to evaluate the blood flow status of the bridge vessel from the left internal thoracic artery to the left anterior descending coronary artery.Results Mean graft flow(MGF)was measured at(21.24±5.71)ml/min,(18.25±7.72)ml/min,(16.47±7.83)ml/min in severe ischemic group,boundary group and mild ischemic group.The results of mean pulsatility index(PI)was 2.58±0.96,3.14±1.19 and 3.53±1.34,the ratio of diastolic flow during the entire graft flow was 0.63±0.10,0.55±0.11 and 0.53±0.11,patients appeared systolic reverse flow was 2 cases(3.6%),3 cases(18.8%)and 3 cases(20.0%),respectively.There were statistically significant differences in MGF(P=0.027)、PI(P=0.007)、the ratio of DF(P=0.001)and the quantity of patients appeared systolic reverse flow(P=0.027)between the three groups.Conclusion Due to increasing severity of coronary artery stenosis,MGF and the ratio of diastolic flow increased,and there appears to be an decreased PI and quantity of patients appeared systolic reverse flow.The chance of bypass graft occlusion may increase for the near and middle term in mild to moderate functional coronary artery stenosis(FFR≥0.75).For patients with severe functional coronary artery stenosis(FFR<0.75),it can obtain satisfactory flow parameters and ideal clinical outcomes.
作者
周胜凯
李梦蝶
赵健
王圣
刘鹏
张国报
程兆云
Zhou Shengkai;Li Mengdie;Zhao Jian;Wang Sheng;Liu Peng;Zhang Guobao;Cheng Zhaoyun(Department of Cardiovascular Surgery,Central China Fuwai Hospital,Central China Fuwai Hospital of Zhengzhou University,Henan Provincial People's Hospital,Zhengzhou 451464,China)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2022年第5期277-280,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
2019河南省医学科技攻关计划省部共建项目(SB201902032)。
