非体外循环冠状动脉旁路移植术应用7-0或8-0 prolene缝线的移植物血管瞬时流量比较研究

赵电彩; 王凯杰; 姬鹏飞; 董小超; 易蔚; 段维勋; 苏洁; 刘金成; 俞世强; 梁宏亮

doi:10.12125/j.chj.202111072

非体外循环冠状动脉旁路移植术应用7-0或8-0 prolene缝线的移植物血管瞬时流量比较研究

Comparative study on transit-time flow measurement of graft conduits with 7-0 or 8-0 prolene suture applied for off-pump coronary artery bypass grafting

摘要

摘要:
目的在非体外循环冠状动脉旁路移植术（OPCABG）中，比较应用7-0 prolene缝线与8-0 prolene缝线行移植物血管远端吻合后的瞬时血流效果。
方法回顾性分析西京医院心血管外科由单一主刀医师完成的OPCABG病例。2019年7月～2020年6月移植物血管远端吻合使用7-0 prolene缝线，2020年7月～2021年6月移植物血管远端吻合使用8-0 prolene缝线。7-0 prolene缝线组纳入421个吻合口，8-0 prolene缝线组纳入397个吻合口。研究对象为移植物血管的瞬时流量测定（TTFM）指标：平均血流量值（MFV），搏动指数（PI）与舒张期充盈百分数（DF）。
结果与7-0 prolene缝线组（n=421）相比，8-0 prolene缝线组移植物血管的MFV（ml/min）显著增加（36±13） vs.（46±16），P<0.05，PI显著降低（2.7±0.65） vs. （2.2±0.5），P<0.05；以不同靶血管做亚组分析，两组的PI在PL或PDA上无显著差异，在LAD上数值上8-0 prolene缝线组（升高）优于7-0 prolene缝线组（P<0.01）。在其余6个亚组上8-0 prolene缝线组的MFV与PI均（升高）优于7-0 prolene缝线组，差异有统计学意义(均P<0.05）。以不同移植物血管材料做亚组分析，8-0 prolene缝线组的MFV均（升高）优于7-0 prolene缝线组（均P<0.05），PI的IMA或RA（P<0.01）、SVG（P<0.05）均（升高）优于7-0 prolene缝线组。两组的DF（%）无显著差异（71±7） vs. （72±12）。
结论在OPCABG移植物血管的远端吻合中使用8-0 prolene缝线可获得更优良的吻合质量。在患者的血管条件与医师的技术能力允许的前提下，应尽可能使用8-0 prolene缝线吻合以提高吻合质量。

Abstract:
AIM To compare the transit-time flow measurement results of graft conduits with 7-0 prolene suture and 8-0 prolene suture in off-pump coronary artery bypass grafting (OPCABG).
METHODS OPCABG cases completed by a single surgeon in the Department of Cardiovascular Surgery in Xijing Hospital were analyzed retrospectively. 7-0 prolene suture was used for distal graft conduit anastomosis from July 2019 to June 2020 and 8-0 prolene suture was used for distal graft conduit anastomosis from July 2020 to June 2021. 421 anastomoses were included in the 7-0 Prolene suture group and 397 anastomoses were included in the 8-0 Prolene suture group. Transit-time flow measurement indexes of graft conduits, including mean blood flow (MFV), pulsatility index (PI) and diastolic filling percentage (DF%), were compared between the use of 7-0 prolene suture and 8-0 prolene suture.
RESULTS Compared with 7-0 Prolene suture group (n=421), MFV (ml/min) of graft vessels in 8-0 Prolene suture group increased significantly (36±13 vs. 46±16, P<0.05）, and PI decreased significantly (2.7±0.65 vs. 2.2±0.5, P<0.05）; In subgroup analysis with different target vessels, there was no significant difference in PL or PDA between the two groups. In lad, the value of 8-0 Prolene suture group (increased) was better than that of 7-0 Prolene suture group (P<0.01). In the other six subgroups, the MFV and PI of 8-0 Prolene suture group were better than that of 7-0 Prolene suture group (all P<0.05). Using different graft vascular materials for subgroup analysis, the MFV of 8-0 Prolene suture group was better than that of 7-0 Prolene suture group (all P<0.05), and the ima or RA (P<0.01) and SVG (P<0.05) of PI were better than that of 7-0 Prolene suture group. There was no significant difference in DF (%) between the two groups (71±7 vs. 72±12).
CONCLUSION The use of 8-0 prolene sutures in distal anastomosis of OPCABG resulted in better anastomotic quality. 8-0 prolene suture should be used to improve the quality of anastomosis if the patient’s vascular conditions and the surgeon’s technical competence allow.

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