加速康复心脏外科麻醉管理在非体外循环冠状动脉旁路移植手术患者中应用价值研究

Value of enhanced recovery after cardiac surgery anesthesia management in patients undergoing off-pump coronary artery bypass grafting

目的探讨加速康复心脏外科(ERACS)麻醉管理在非体外循环冠状动脉旁路移植手术(OP-CABG)患者中的应用价值。方法选取北部战区总医院自2020年6月至2021年1月收治的50例行OP-CABG的患者为研究对象。根据不同麻醉方式将患者分为常规麻醉组与ERACS组,每组各25例。常规麻醉组采取常规麻醉方案,ERACS组采取以减少阿片类用药的平衡麻醉和以术后即刻拮抗肌松残余作用为核心的ERACS麻醉方案。记录并比较两组患者术后拔管时间、重症监护室(ICU)驻留时间、住院时间、血管活性药支持时间、经口进食水时间、术后不良事件发生情况及满意度。结果ERACS组患者的术后拔管时间、ICU驻留时间、住院时间、血管活性药支持时间及经口进食水时间均显著短于常规麻醉组,差异均有统计学意义(P<0.05)。ERACS组患者不良事件发生率为32.0%(8/25),低于常规麻醉组的48.0%(12/25),差异有统计学意义(P<0.05)。ERACS组患者满意度为96.0%(24/25),高于常规麻醉组的92.0%(23/25),差异有统计学意义(P<0.05)。结论ERACS麻醉管理方案应用于OP-CABG患者安全有效,术后拔管时间与ICU驻留时间均较短,且患者恢复快、满意度高。

Objective To investigate the value of enhanced recovery after cardiac surgery(ERACS)anesthesia management in patients undergoing off-pump coronary artery bypass grafting(OP-CABG).Methods Fifty OP-CABG patients admitted to General Hospital of Northern Theater Command from June 2020 to January 2021 were selected as the research subjects.Patients were divided into conventional anesthesia group and ERACS group according to different anesthesia methods,with 25 patients in each group.In the ERACS group,a series of anesthesia management measures centered on balanced anesthesia with opioid reduction and immediate postoperative antagonism of muscle relaxation residual effects were implemented.Postoperative extubation time,intensive care unit(ICU)stay time,hospital stay time,vasoactive drug support time,oral water intake time,postoperative adverse events and satisfaction were recorded and compared between the two groups.Results Postoperative extubation time,ICU stay time,hospital stay time,vasoactive drug support time and oral water intake time in ERACS group were significantly shorter than those in conventional anesthesia group,with statistical significance(P<0.05).The incidence of adverse events in ERACS group was 32.0%(8/25),lower than that in conventional anesthesia group 48.0%(12/25),and the difference was statistically significant(P<0.05).The patient satisfaction rate of ERACS group was 96.0%(24/25),which was higher than that of conventional anesthesia group 92.0%(23/25),and the difference was statistically significant(P<0.05).Conclusion ERACS anesthesia management is safe and effective in OP-CABG patients,with short postoperative tracheal tube removal and ICU stay,and with rapid recovery and high satisfaction.