非体外循环冠状动脉搭桥手术的麻醉处理

The Management of Anesthesia of Off-pump Coronary Artery Bypass Grafting(OPCABG)

目的 :探讨非体外循环冠状动脉搭桥手术的麻醉处理技术。方法 :选择ASAⅡ -Ⅲ级 ,拟行非停跳下冠状动脉搭桥术病人 32例 ,术前行降压、扩冠治疗。全部病例均采用芬太尼—异氟醚静脉和吸入复合全麻 ;术中观察麻醉诱导后、插管前、搬动心脏、上侧壁钳等时刻的动脉压、心率、中心静脉压变化 ;应用去氧肾上腺素、间羟胺调控血压 ,硝酸甘油扩冠 ,多巴胺辅助循环 ,艾司洛尔控制心率 ,控制芬太尼总量在 30～ 4 0 μg/kg。结果 :全部病人麻醉过程顺利 ,麻醉诱导、插管及术中血压基本稳定 ,心率控制满意。平均搭桥 2 4枝 ,平均手术时间3 5 6± 0 84h ,术后 6h内拔出气管导管。全部病例均顺利康复。结论 :非体外循环冠状动脉搭桥手术麻醉处理关键是麻醉诱导和术中平稳 ;合理应用血管活性药物维持血流动力学稳定 ,保证心肌氧供需平衡 ;中等剂量芬太尼—异氟醚静吸复合全麻是非体外循环冠状动脉搭桥手术较理想的麻醉方法。

Objective:To investigate the technolog of anesthesic manage-ment of OPCABG.Methods:32 ASAⅡ-Ⅲ patients scheduled for OPCABG were studied.All of these patients were treated with lowering blood pressure and enlarging coronary artery before operation.All of them were operated upon under fentanyl-isofurane general anesthesia.during operation,the artery blood pressure,heart rate,center vein pressure were observed affer anesthesia induced,before the catheter insented and just as the hearts being removed and the side wall clamp being nipped.Phenylephrine and metaraminol were applied to mediate and control blood pressure;Nitroglycerin was applied to enlarge coronary artery;Dopamine was applied to assist circulation and Esmolol was applied to control heart rate.Every minute fentanyl 30～40μg/kg was given during operation.Results:All patients were all right in the anesthesic process such as anesthesia induled and catheter inserted.the blood pressure and heart nate were controled satisfactorily.The mean coronary artery bypass grafting was 2～4 branches.The mean operation time was 3.56±0.84h.The erachea catheter was pulled out 6H affer operation.All these patients got well later.Conclusion:The key point of the management of anesthesia of OPCABG is to ensure anesthesia inducedt and operation calm,to keep the blood stream dynamics steady with angiotenic medicament,to keep the myocardic oxygen delivery and consumption a balance.Medium dosage of fentanyl-isoflurane general anesthesia is a perfect anesthesic method for OPCABG.