冠心病合并糖尿病患者非体外冠脉搭桥术麻醉分析

Clinical Analysis on off-pump Coronary Artery Bypass Grafting for Coronary Artery Disease Combined with Diabetes Mellitus

目的:探讨冠心病合并糖尿病患者非体外冠脉搭桥术麻醉管理方法。方法:38例冠心病合并糖尿病患者在静吸复合麻醉下行非体外冠脉搭桥术(OPCABG)。术中采用持续泵注1∶1胰岛素控制血糖。记录术前、劈胸骨后、搭前降支后、关胸各时段的血液动力学改变和血糖值。结果:38例患者术中虽然血压有所波动,但保持了较稳定的心率。手术开始后患者中心静脉压(CVP)普遍较低。劈胸骨等强烈刺激后患者血糖比术前明显升高(P<0.05),经过处理后逐渐降低。结论:OPCABG应注重围术期血糖监测,合并糖尿病患者围术期应精确控制血糖,补充容量,维持水电解质酸碱平衡,有利于维持稳定的血液动力学。

Objective： To analyse the anesthetic management on undergoing of/-pump coronary artery bypass grafting（OPCABG） for coronary artery disease（CAD） combined with diabetes mellitus. Methods： thirtyeight patients undergoing OPCABG were anesthetized with propofol, fentanyl, vecuronium combined with anflurane. Intravenous blood samples were taken for blood glucose concentrations analysis and MAP and CVPand HR were recorded before operation（baseline）, 5min after splitting the breastbone, grafting LAD, 5rain after closure of the chest. Insulin was given i. v at 0～5u/h after blood glucose concentrations were measured at second time. Results：The level of blood glucose was improved after incising the skin and splitting the breastbone （P〈0. 05）,after that,was decreased gradually after the infusion of insulin. CVP of thirty-eight cases were significantly low at the beginning of the operation. Conclusion：The blood glucose concentrations must be regulated exactly at perioperative period in OPCABG of CAD combined with diabetes mellitus.