重症冠心病患者冠状动脉搭桥术的麻醉处理

Anesthetic management of patients with severe coronary heart disease undergoing coronary artery bypass grafting

目的探讨重症冠心病患者冠状动脉搭桥手术的麻醉处理。方法对68例重症冠心病患者冠状动脉搭桥术的麻醉进行回顾分析,采用小剂量芬太尼、异丙酚、异氟烷复合全身麻醉,持续监测心电图、脉搏、氧饱和度、呼气末二氧化碳、平均动脉压、中心静脉压及动脉血气,部分患者监测心输出量、心脏指数、外周血管阻力、肺血管阻力、每搏量、平均肺动脉压。结果全组共搭动脉桥18支、静脉桥116支,同期行室壁瘤切除3例,瓣膜置换30例,室间隔穿孔修补术1例。围术期发生低心排5例、呼吸衰竭1例、肾功能不全1例,多器官功能衰竭1例,死亡4例,1例患者于术后第3天并发多器官功能衰竭死亡,另3例患者并发低心排死亡,死亡率5.89%;结论术前尽量改善心功能并给予充分的镇静,降低心肌耗氧;维持血流动力学的稳定是重症冠状动脉搭桥术麻醉管理的关键,可降低死亡率和术后并发症。

Objective To explore the anesthetic management of patients with severe coronary heart disease undergoing coronary artery bypass grafting. Methods The anesthetic management of 68 patients with severe coronary heart disease undergoing coronary artery bypass grafting were retrospectively analysed, the anesthesia was induced with small dose fentanyl, propofol and isoflurane, ECG,SpO2 ,PETCO2, MAP,CVP were monitored continuously, and CO, CI, SVR, PVR, SV, MPAP were monitored in partial patients. Results Totally 18 artery-vessels and 116 venous-vessels were transplanted to patients,combined with operative procedures included 3 cases of ventricular aneurysm resection,30 cases of valve replacement,and 1 case of surgical repair of perforation of ventricular septum. Post-operative complications included 3 cases of low cardiac output, 1 case of respiratory failure, 1 case of renal failure,and 1 case multiple organ failure. Three patients died and the mortality was 5.89 %. Conclusion It is important to keep the hemodynamics stable, and decrease the incidence of mortality and complications.