100例非体外循环冠状动脉搭桥术麻醉的循环管理分析

Analysis of hemodynamic changes in 100 patients undergoing off-pump coronary artery bypass surgery

目的通过对100例非体外循环冠状动脉搭桥术(OPCABG)麻醉回顾性分析,探讨OPCABG术中循环管理方法。方法分析100例患者在吻合前降支(LAD)、右冠状动脉(RCA)、对角支(DIAG)、回旋支(CX)不同靶血管的血流动力学参数包括心率(HR)、平均动脉压(MAP)、平均肺动脉压(MPAP)、中心静脉压(CVP)、混合静脉血氧饱和度(SvO2)和心输出量(CO)的变化情况。结果OPCABG患者术中吻合各冠脉分支时血流动力学参数均出现不同程度的变化,主要表现为MAP、CO下降,CVP升高,尤以远端吻合CX和RCA时变化明显。结论OPCABG中血管吻合阶段常导致血流动力学的波动,尤其是吻合CX和RCA时,原因主要是受心脏固定器压迫和心脏位置改变造成右室舒张功能不全和血流动力学衰减,经过恰当处理均能保持血流动力学情况的基本稳定。

Objective To analyze retrospectively 100 patients who underwent off-pump coronary artery bypass grafting surgery （OPCABG）in order to summarize the hemodynamic changes. Methods One hundred patients undergoing OPCABG were collected and analyzed retrospectively. To analyze the hemodynamic changes including heart rate（HR） ,mean arterial pressure（MAP）,central venous pressure（CVP）, mean pulmonary artery pressure（ MPAP）, mixed venous oxygen（SVO2 ） and cardiac output（CO）. The changes of hemodynamic were recorded at the moment of every graft anastmosised and during left circumflex coronary artery （LCX） anastmosised. Results The Patients undergoing OPCABG had hemodynamic derangements during cardiac displacement： MAP and CO decreased significantly in all territories （P〈0.05 or P〈0.01 ） ,CVP increased significantly in all anastomosed distal blood ves- sels. That was serious when the CX or RCX was performed. Conclusion Cardiac displacement and compression induced by exposure and anastomosis of distal blood vessels during OPCABG bring usually hemodynamic changes, especially in CX and RCA territories. Those hemodynamic changes are transient and well tolerated under suitable anesthetic management.