【摘要】：目的:觀察不停跳冠狀動脈搭橋術(shù)中血壓對橋血流量的影響,指導(dǎo)冠脈搭橋術(shù)中及術(shù)后血壓的調(diào)節(jié)。方法:選擇首都醫(yī)科大學(xué)附屬北京朝陽醫(yī)院2016年8月-10月行不停跳冠狀動脈搭橋手術(shù)患者31例,術(shù)前檢查無明顯手術(shù)禁忌,取左乳內(nèi)動脈及大隱靜脈備用作為移植橋血管,術(shù)中應(yīng)用瞬時(shí)血流量測量儀(TTFM)、心電監(jiān)護(hù)儀及心排儀等多次重復(fù)測量并記錄患者各橋血管瞬時(shí)的收縮壓、舒張壓、肺動脈壓、心輸出量、中心靜脈壓、心率、心排量、搏動指數(shù)及橋血流量等指標(biāo)。記錄數(shù)據(jù)并采用觀察法及差值法進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:舒張壓:對前降支橋血流量影響(P=0.818,r2=0.669)、對右冠橋血流量影響(P=0.674,r2=0.469)、對回旋橋血流量影響(P=0.817,r2=0.669)均呈顯著影響且具有統(tǒng)計(jì)學(xué)意義。收縮壓:對前降支橋血流量影響(P=0.685,r2=0.469)、對右冠橋血流量影響(P=0.637,r2=0.417)、對回旋橋血流量影響(P=0.780,r2=0.610)具有統(tǒng)計(jì)學(xué)意義。但是收縮壓對前降支橋血流量影響較小。這與血流量圖像相符。但是與泊肅葉血流公式不相符原因可能與冠脈血流量除受上述因素影響外還受自身調(diào)節(jié)及心肌舒縮活動的影響。結(jié)論:血壓尤其是舒張壓對三大主支血管均呈顯著影響;而收縮壓對各個(gè)橋的血流量影響差異較大;掌握血壓對橋血流量的影響規(guī)律,對提高冠脈搭橋手術(shù)術(shù)中質(zhì)量、避免圍手術(shù)期心肌梗死等并發(fā)癥的發(fā)生、指導(dǎo)術(shù)后及遠(yuǎn)期血壓調(diào)節(jié)有臨床意義。
[Abstract]:Aim: to observe the effect of blood pressure on blood flow during coronary artery bypass grafting (CABG) and to guide the blood pressure regulation during and after coronary artery bypass grafting (CABG). Methods: Thirty-one patients underwent coronary artery bypass grafting in Beijing Chaoyang Hospital affiliated to Capital Medical University from August to October 2016. There were no obvious contraindications in preoperative examination. The left internal mammary artery and saphenous vein were taken as graft vessels. Transient blood flow monitor (TTFM),) and cardiac output instrument (TTFM),) were used to measure and record the transient systolic blood pressure, diastolic blood pressure, pulmonary artery pressure, cardiac output, central venous pressure, heart rate and cardiac output. Pulsatility index and bridge blood flow. The data were recorded and analyzed statistically by observation method and difference method. Results: diastolic blood pressure (DBP) had an effect on the blood flow of anterior descending branch bridge (P < 0. 818), right coronary artery bridge (P < 0. 674), right coronary artery bridge (P = 0. 674), circumflex blood flow (P = 0. 817, P = 0. 817). R _ 2 ~ (6. 669) was significant and statistically significant. Systolic blood pressure (SBP): the effect on the blood flow of the anterior descending branch bridge (P < 0. 685), the right coronal bridge (P = 0. 637) and the circumflex bridge (P = 0. 780) was statistically significant. But systolic blood pressure has little effect on the blood flow of anterior descending branch bridge. This is consistent with the blood flow image. However, the reasons for the inconsistency with Posule's blood flow formula may be related to the influence of coronary blood flow, including self-regulation and myocardial systolic and diastolic activity, in addition to the above factors. Conclusion: blood pressure, especially diastolic blood pressure, has a significant effect on the blood flow of the three major branches, while systolic blood pressure has a great effect on the blood flow of each bridge. Mastering the effect of blood pressure on graft blood flow, improving the quality of coronary artery bypass surgery, avoiding complications such as perioperative myocardial infarction, and guiding postoperative and long-term blood pressure regulation have clinical significance.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R654.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 宋躍;張健群;黨海明;劉韜帥;鄭居兵;李揚(yáng);曹劍;吳立松;;術(shù)中即時(shí)橋血管流量測定在不停跳冠狀動脈旁路移植術(shù)中的應(yīng)用研究[J];心肺血管病雜志;2012年01期

2 戴宇翔;李晨光;黃浙勇;仲昕;錢菊英;劉學(xué)波;葛雷;樊冰;王齊冰;張峰;黃東;姚康;馬劍英;朱明輝;葛均波;;冠狀動脈血流緩慢患者臨床及造影結(jié)果的特點(diǎn)分析[J];中華心血管病雜志;2011年07期

3 胡大一;;對無保護(hù)左主干冠狀動脈狹窄血運(yùn)重建的臨床決策[J];醫(yī)學(xué)與哲學(xué)(臨床決策論壇版);2008年09期

4 孫毅;馬潤偉;張桂敏;蔡冰;宋怡;夏健明;白向鋒;;犬左乳內(nèi)動脈Y橋重建冠脈血運(yùn)后血流量變化[J];山東醫(yī)藥;2008年18期

5 高杰;蘇丕雄;張希濤;劉巖;安向光;顏鈞;顧松;;不停跳冠脈搭橋術(shù)中重建前降支血供前、后血流動力學(xué)分析[J];中國心血管病研究;2008年06期

6 崔仲奇;楊碧波;高峰;刁國華;馬旭東;;體外循環(huán)與非體外循環(huán)下冠狀動脈旁路移植術(shù)移植血管流量對比分析[J];中國微創(chuàng)外科雜志;2008年01期

7 張濤;高長青;李伯君;肖蒼松;吳揚(yáng);姜?jiǎng)倮?;冠狀動脈旁路移植術(shù)大隱靜脈橋的平均流量及影響因素分析[J];中華外科雜志;2006年02期

8 馬潤偉,吳若彬,郭惠明;冠狀動脈搭橋術(shù)中橋血流測量方法的演進(jìn)[J];心血管病學(xué)進(jìn)展;2005年01期

9 王東城,王懷陽,吳曉明,岑人經(jīng);灌注壓變化對左冠脈血流影響的建模和仿真研究[J];醫(yī)用生物力學(xué);2004年01期

10 高長青,肖蒼松,李伯君,張濤,王剛,王奇;國人橋血流搏動指數(shù)的研究[J];中華胸心血管外科雜志;2004年01期

，

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