非体外循环冠状动脉旁路移植术的麻醉方法及围术期处理

Method of anesthesia and perioperative management for off-pump coronary artery bypass grafting

目的探讨非体外循环冠状动脉旁路移植术（0PCABG）的麻醉方法、围术期处理以及对患者各项检测指标变化的影响。方法113例OPCABG患者采用咪唑安定0．05mg／kg、氯胺酮0．5mg／kg、万可松0．13～0．15mg／kg、芬太尼5～10μg／kg诱导麻醉，按需给予万可松、芬太尼，吸入异氟醚，泵入丙泊酚维持。于心包吊线，悬吊心脏，安放前降支、后降支、左旋支心表固定器，上主动脉侧壁钳操作前及操作中，观察并记录血流动力学指标、心电图ST段的变化以及利多卡因对心包吊线时心律的影响。结果在各项操作中，平均动脉压（MAP）、心率（HR）虽较操作前有所下降，但均在临床可接受范围内，并能很快恢复；心肌耗氧指标心率收缩压乘积（RPP）结果显示，减少心肌耗氧效果较好；心电图ST段在各操作前与操作中比较差异无统计学意义（P均〉0．05）。心包吊线前给予1mg／kg的利多卡因可以明显降低心包吊线时室性期前收缩的发生程度。结论本组麻醉方法对OPCABG患者是安全的，围术期处理对术中维持循环平稳，保持氧供及氧耗平衡是有效和令人满意的。

Objective To investigate the method of anesthesia and perioperative management for offpump coronary artery bypass grafting （OPCABG）, and to examine the hemodynamic changes during the operation. Methods One hundred and thirteen patients undergoing OPCABG were studied. Anesthesia induction was achieved by giving midazolam 0.05 mg/kg, ketamin 0. 5 mg/kg, vecuronium 0.13 - 0.15 mg/kg and fentanyl 5 - 10μg/kg. Vecuronium and fentanyl were given as needed, isoflurane and propofol were administered for maintenance. Hemodynamic indexes, ST-segment change in electrocardiogram （ECG） and lidocaine＇s influence to the cardiac rhythm were observed and recorded during the main process of operation. Results Observation before and during the operation showed that mean arterial pressure （MAP） and heart rate （HR） decreased a little but within clinical acceptable range, at the beginning, and it recovered soon. The result of rate-pressure product （RPP） showed that the reduction of cardiac muscle oxygen consumption was satisfactory. There was no significant change in ST-segment in ECG （P〉0.05） before and during the main procedure. Giving 1 mg/kg lidocaine before the operation could obviously lower the possibility or degree of premature ventricular extrasystole. Conclusion OPCABG can be performed safely under the above method of anesthesia. The perioperative management is effective and satisfactory in maintaining stable circulation and in keeping oxygen supply and consumption balance.