骨骼化胸廓内动脉在冠状动脉旁路移植术中的应用优势

亓先杰; 王亚涛; 魏婷; 刘戈; 姜亦瑶; 施超

doi:10.16766/j.cnki.issn.1674-4152.002886

骨骼化胸廓内动脉在冠状动脉旁路移植术中的应用优势

doi: 10.16766/j.cnki.issn.1674-4152.002886

蚌埠医学院第一附属医院心脏外科，安徽蚌埠 233004

基金项目:

国家自然科学基金青年科学基金项目 81800214

安徽省自然科学基金青年项目 1808085QH236

蚌埠医学院转化医学重点项目 BYTM2019041

蚌埠医学院2021年度研究生科研创新计划项目 Byycx21077

详细信息

通讯作者:
施超，E-mail: wuweishichao@126.com

中图分类号: R654
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出版历程
- 收稿日期: 2022-10-10
- 网络出版日期: 2023-04-19

Advantages of using skeletonized internal thoracic artery for coronary artery bypass grafting

Department of Cardiac Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的骨骼化胸廓内动脉广泛应用于冠状动脉旁路移植术中，本研究对骨骼化胸廓内动脉与术后胸壁疼痛及感觉异常的相关性进行分析。方法选取2020年9月—2021年1月蚌埠医学院第一附属医院70例体外循环下冠状动脉旁路移植术患者进行回顾性分析。其中36例患者为骨骼化胸廓内动脉移植物，另外34例患者为带蒂胸廓内动脉移植物。结果术中测得骨骼化胸廓内动脉移植物组胸廓内动脉桥血管流量为42.0(33.0，53.5)mL/min、搏动指数为2.75(2.15, 3.60)与带蒂胸廓内动脉移植物组[41.0(27.0，51.0)mL/min、3.10(2.20, 3.60)]比较差异无统计学意义(均P＞0.05)；术后1个月，骨骼化胸廓内动脉移植物组的疼痛残疾指数[3(2，3)]低于带蒂胸廓内动脉移植物组[5(4，5)，P＜0.05]；术后1个月、1年，骨骼化胸廓内动脉移植物组的感觉异常发生率低于带蒂胸廓内动脉移植物组，差异有统计学意义(均P＜0.05)。结论骨骼化胸廓内动脉移植物能够提供不逊色于带蒂胸廓内动脉移植物的桥血管流量，并且不增加桥血管搏动指数(流体阻力)。长期来看，骨骼化胸廓内动脉能降低术后胸壁感觉异常发生率，但不能减少冠状动脉旁路移植术后疼痛。
- 冠状动脉旁路移植术 /
- 骨骼化胸廓内动脉 /
- 桥血管流量 /
- 疼痛 /
- 感觉异常
Abstract: Objective Skeletonized internal thoracic arteries (ITA) are widely used in coronary artery bypass grafting. The aim of this study is to analyze the correlation between the skeletonized internal thoracic artery and postoperative chest wall pain and paresthesia. Methods Seventy patients who underwent coronary artery bypass grafting with extracorporeal circulation in the First Affiliated Hospital of Bengbu Medical College from September 2020 to January 2021 were selected for retrospective analysis. Among them, 36 patients had skeletonized ITA grafts and 34 patients had pedicled ITA grafts. Results There were no significant differences in the mean flow and pulse index of ITA grafts between skeletonized ITA grafts [42.0 (33.0, 53.5) mL/min, 2.75 (2.15, 3.60)] and pedicled ITA grafts [41.0 (27.0, 51.0) mL/min, 3.10 (2.20, 3.60)], all P>0.05. At 1 month postoperatively, the pain disability index was lower in the skeletonized ITA graft group [3 (2, 3)] than in the pedicled ITA graft group [5 (4, 5)], and the difference was statistically significant (P < 0.05). The incidence of paresthesia was lower in the skeletonized ITA graft group than in the pedicled ITA graft group at 1 month and 1 year postoperatively, with statistically significant differences (both P < 0.05). Conclusion Skeletonized ITA grafts are able to provide bridge vessel flow that was not inferior to that of pedicled ITA grafts and do not increase the bridge vessel pulsatility index (fluid resistance); In the long term, skeletonization of the ITA can reduce the incidence of postoperative chest wall paresthesia, but does not reduce post-coronary artery bypass grafting pain.
- Coronary artery bypass grafting /
- Skeletonized internal thoracic arteries /
- Bypass flow /
- Pain /
- Paresthesia

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表 1 2组冠状动脉旁路移植术患者术前基本情况比较

Table 1. Comparison of preoperative basic conditions of patients undergoing coronary artery bypass grafting between the two groups

组别	例数	性别(例)		年龄 [M(P₂₅, P₇₅)，岁]	BMI (x±s)	高血压 (例)	糖尿病 (例)	高血脂 (例)	肾小球滤过率 (x±s，mL/min)	左心室射血分数 [M(P₂₅, P₇₅)，%]
组别	例数	男性	女性	年龄 [M(P₂₅, P₇₅)，岁]	BMI (x±s)	高血压 (例)	糖尿病 (例)	高血脂 (例)	肾小球滤过率 (x±s，mL/min)	左心室射血分数 [M(P₂₅, P₇₅)，%]
骨骼化胸廓内动脉移植物组	36	27	9	60.5(57.0，63.5)	25.89±3.41	20	11	24	104.92±26.08	55.0(53.5，59.0)
带蒂胸廓内动脉移植物组	34	31	3	64.0(56.0，69.0)	25.42±3.10	25	7	28	97.80±27.37	57.0(50.0，61.0)
统计量		3.221^a		-1.235^b	0.598^c	2.460^a	0.909^a	2.252^a	1.114^c	-0.230^b
P值		0.073		0.217	0.552	0.117	0.340	0.133	0.269	0.818
注：^a为χ²值，^b为U值，^c为t值。

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表 2 2组冠状动脉旁路移植术患者手术相关指标比较

Table 2. Comparison of operation related indicators between the two groups of patients undergoing coronary artery bypass grafting

组别	例数	桥血管流量 [M(P₂₅, P₇₅)，mL/min]	桥血管搏动指数 [M(P₂₅, P₇₅)]	体外循环时间 (x±s，min)	搭桥数量 [M(P₂₅, P₇₅)]
骨骼化胸廓内动脉移植物组	36	42.0(33.0，53.5)	2.75(2.15, 3.60)	153.75±61.34	3(2，3)
带蒂胸廓内动脉移植物组	34	41.0(27.0，51.0)	3.10(2.20, 3.60)	166.09±44.48	3(2，3)
统计量		-0.594^a	-0.500^a	-0.959^b	-0.810^a
P值		0.553	0.617	0.341	0.418
注：^a为U值，^b为t值。

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表 3 2组冠状动脉旁路移植术患者术后实验室检查及住院时间比较[M(P₂₅, P₇₅)]

Table 3. Comparison of laboratory tests and length of hospital stay after coronary artery bypass grafting between the two groups[M(P₂₅, P₇₅)]

组别	例数	血肌酐 (μmol/L)	丙氨酸氨基转移酶(U/L)	天门冬氨酸氨基转移酶(U/L)	术后住院时间 (d)
骨骼化胸廓内动脉移植物组	36	88.5(71.0, 104.0)	30.5(16.5, 37.0)	53.5(39.0, 63.0)	14.0(11.5，17.0)
带蒂胸廓内动脉移植物组	34	89.5(78.0, 105.0)	28.5(17.0, 38.0)	48.0(37.0, 68.0)	19.0(15.0, 24.0)
U值		-0.846	-0.294	-0.253	-4.023
P值		0.397	0.769	0.800	＜0.001

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