非体外循环冠状动脉旁路移植术中血流动力学和氧供需变化及麻醉处理

Changes of arterial blood gases,hemodynamics and anaesthetic management during off-pump CABG

目的 观察非体外循环冠状动脉旁路移植术中处理三支主要冠状动脉分支引起的血流动力学和氧供需改变，并对原因作初步分析，为麻醉处理提供依据。方法 选择我院2004年1月-2005年12月择期行非体外循环冠状动脉旁路秽植术符合标准的60倒病人。手术开始后，记录以下5点的血流动力学数值：（1）开胸始；（2）暴露和固定前降支后；（3）暴露和固定左回旋支冠状动脉后；（4）暴露和固定右冠状动脉后；（5）术毕。记录（1），（4），（5）点血气。结果 血流动力学发生了明显的改变，平均动脉血压、心指数下降，而心率、中心静脉压升高，平均肺动昧压、肺动脉楔压升高。动脉血气改变，动脉血乳酸水平升高。结论 本组病人行非体外循环冠状动脉旁路移植时，血流动力学发生了变化，经及时处理完成手术。氧供逐渐减少，氧耗量没有明显的改变，氧代谢紊乱及缺氧程度较轻。

Objective To examine the changes of hemodynamics and arterial blood gases during off-pump coronary artery bypass grafting, make an elementary analysis of the causes and provide foundation for the anaesthetic management. Methods Sixty patients undergoing selective OPCAB from Janu. 2004 to Dec. 2005 were selected in the study. Hemodynamic measurements were recorded after preoperational （BASE） from the following five aspects： exposure and stabilization of the left anterior desending artery （LAD） ,the left circumflex coronary （LCX） ,the right coronary artery （RCA） and the last one before closing thoracic （END）. Arterial blood gases were performed after preoperation,exposure and stabilization of the right coronary artery and before closing thoracic. Results There were obvious hemodynamic changes. MAP,CI decreased while HR,CVP,MPAP,PAWP increased. Arterial blood gases changed and the Lactic Acid level increased in some degree. Conclusions All patients complete off-pump CABG successfully after anaesthesia management in time, although the hemodynamics has changed. The supply of the oxygen decreases but the changes of the consumed oxygen are not obvious. There is no obvious Oxygen metabolism changes and only slight t hypoxia.