非体外循环下冠状动脉搭桥术的麻醉管理

Off-pump coronary artery bypass surgery anesthesia management

目的分析非体外循环下冠状动脉搭桥术OPCABG血流动力学的变化，探讨OPCABG的麻醉管理。方法择期行OPCABG的冠心病患者120例，年龄48～76岁，射血分数平均（0．53±0．32），术前放置漂浮导管，监测血液动力学变化，分别在开胸前（T0）、吻合前降支（T1）、吻合回旋支（T2）、吻合对角支（L）、吻合右冠状动脉（T4）、心脏恢复原位置后（L）分别记录MAP、HR、CVP、PCWP、CI、CO、Sv02、SVRI、PVRI、LVSWI、RVSWI。结果吻合前降支时CI、LVSWI下降，PVRI增高，SvO2正常。吻合回旋支、对角支、右冠状动脉时，CI、CO、LVSWI、RVSWI、SvO2明显下降（P〈0．01），而HR、CVP、PCWP、PVRI增高（P〈0．05）。结论术者翻动心脏可导致明显血流动力学变化，动作要轻，采取必要的心血管功能支持，避免发生严重低血压和心率失常。

Objective To analyze the non-pump coronary artery bypass grafting OPCABG hemodynamits,anesthetic management of OPCABG. Methods Elective OPCABG 120patients with coronary heart disease, aged 48 - 76years, mean ejection fractio （ 0. 53 ± 0. 32 ）, preoperative catheter placed to monitor hemodynamic changes were in the open chest （TO ） ,left anterior descending artery anastomosis （T1 ） , circumflex artery anastomosis（ T2 ）, diagonal branch anastomosis（ T3 ） , Right coronary artery anastomosis （T4）, heart restore the original location（ T5 ） were recorded MAP, HR, CVP, PCWP, CI, CO, SvO2 , SVRI, PVRI, LVSWI, RVSWI. Resnlts When left anterior descending artery anastomosis CI, LVSWI down, PVRI increased, SvOz was normal. Consistent with circumflex, diagonal branch, right coronary artery when, CI, CO, LVSWI, RVSWI, SvO2 significantly decreased（P 〈0. 01） ,and HR,CVP,PCWP,PVRI increased（P 〈0.05）. Conclusion Heart patients who flip can lead to significant hemodynamic changes, action should be light, take the necessary support cardiovascular function, to avoid serious hypotension and cardiac arrhythmias.