非体外循环冠状动脉搭桥术的麻醉管理

Anesthetic Management and Tracheal Extubationof Patients Undergoing Off-pump Coronary Bypass Grafting (OPCABG)

目的探讨非体外循环下冠状动脉搭桥术病人的围术期管理及术后拔管。方法择期非体外循环下冠状动脉旁路移植术病人68例,采用异丙酚、芬太尼、维库溴铵、安氟醚等静吸复合全麻。硝酸甘油、佩尔地平、艾司洛尔、去甲肾上腺素、多巴胺、多巴酚丁胺等用于调控血流动力学指标。观察术后清醒时间、拔管时间和入住重症监护室(ICU)时间。结果所有病人的清醒时间、拔管时间和入住ICU时分别为(78±42)min、(2.5±2.0)h、(8.2±6.3)h。术毕62例病人在4 h内拔管。66例预后良好,无麻醉并发症。结论施行“快通道”心脏麻醉,有利于术后早期拔管,减少病人在ICU的监护时间。非体外循环下冠状动脉搭桥术麻醉管理的关键,是维持血流动力学平稳和心肌氧供与氧耗的平衡。

Objective To investigate the anesthetic management and tracheal extubation of patients undergoing off- pump coronary artery bypass grafting. Methods 68 patients underwent off- pump coronary artery bypass grafting were anesthetized with pmpofol, fentanyl, vecumnium combined with anflurane, nitroglycerin, perdiping, emnolol, Phenylephrine, dopamine were used to control patients hemodynimics. Consciousness recovery time, tracheal extubation time and stay in intensive care unit （ICU） time were observed. Results All patients consciouseness recovery time, tracheal extubafion time and stay in ICU were （78 ± 42） min, （2.5 ± 2.0） hours, （8.2 ± 6.3） hours. Tracheal intubation were remained 4 hours in 62 patients aftempemtion, 66 patients had good recovery without any anesthesia complications. Conclusion Administration of VIVA benefits early tracheal extubation after operation and shortens the stay in ICU. The key of perioperafive management of patients undergoing off- pump coronary artery bypass grafting depends on the maintenance of hemodynamics stability and the equilibriuna between myocardial oxygenic supply and oxygenic consuming.