非体外循环冠状动脉旁路移植术的麻醉处理

Anesthetic management for off-pump coronary artery bypass grafting.

目的探讨常温、非体外循环下不停跳冠状动脉旁路移植术（OPCABG）的麻醉与管理办法。方法选择2004年7月．2006年6月的35例择期OPCABG患者进行综合分析。采用咪唑安定、依托米酯、芬太尼、哌库溴铵、异丙酚、异氟烷行气管插管静吸复合全麻，术中监测ECG、IBP、SpO2、HR、CVP及PA、PCWP、CCO、SvO2等，应用硝酸甘油、多巴胺、艾司络尔、乌拉地尔、去氧肾上腺素、山莨菪碱等控制MAP在60～90mmHg范围，HR在50～70次／min范围，保持基本生命体征稳定。结果34例在非体外循环下完成，1例在体外循环下完成，术中循环稳定，无麻醉并发症，均恢复良好，康复出院。结论OPCABG因要求心脏不停跳，其麻醉与管理比体外循环下冠脉搭桥（CABG）要求更高，关键是维持心肌氧供需平衡，保持血液动力学的稳定，避免加重心肌氧耗，造成围术期心肌缺血甚至心肌梗死。

Objective To investigate the anesthetic management for patients underwent off-pump coronary artery bypass grafting （OPCABG） .Methods Between July .2004 and June.2006.35 patients underwent OPCABG were entered into the study. Patients were anesthetized with midazolam, E tomidate, fentanyl, pipecuronium bromide, Propofol and isoflurane, monitored ECG, IB P,. SPO2 , HR, CVP, PA,PCWP,CCO,and SvO2 during surgery, nitroglycerin（ NTG） was dripped continuously.and dopamine,esmolol,anisodamlne was given if needed to maintain stable cardiovascular function and myocardial oxygen supply-demand balance. Results Thirty four eases were suecessful.one of the cases was changed to extracorporeal circulation, there was no anesthesla-related complication. Conclusion To maintain the hemodynauic stable and keep the balance of oxygen supply and demand are the role of anesthesia management for the off pumpcoronary artery bypass grafting.