冠状动脉旁路移植术120例的术后监测与处理

Post operative Management for 120 Cases Coronary Artery Bypass Surgery

目的 探讨冠状动脉旁路移植术后在监护病房（ＩＣＵ）的管理措施。方法 对１２０ 例接受冠状动脉旁路移植术患者的临床资料进行回顾性总结分析。结果 ９０％ 的患者术后８ ｈ 内能早期拔除气管插管，早期下床活动，无肺炎、肺不张等并发症，全组无围术期死亡。并发严重低心排３例，经主动脉内球囊反搏（ＩＡＢＰ）支持２４ ｈ 好转。１２ 例因出（渗）血行２ 次开胸止血，清除血块。结论 冠状动脉旁路移植术后早期在ＩＣＵ 保持心肌氧供（氧需）的平衡，减少氧耗；保持足够的心排血量，维持循环平稳；预防心律失常；减少术后渗（出）血是病人得以顺利恢复的关键。

Objective\ To evaluate the post operative management for coronary artery bypass surgery in the intensive care unit. Methods\ The clinical data of 120 cases with coronary artery bypass surgery were reviewed retrospectively. Results\ 90% of these patients were extubated within 8 hours post operatively, and this made early ambulatory possible. There were neither complications in respiratory system nor perioperative death in this small group. Three patients developed low cardiac output syndrome, who needed IABP support for less then 24 hours. 12 were reopened to stop bleeding. Conclusion\ Successful management in the intensive care for the patients after coronary bypass surgery is: 1. Balance oxygen supply and demands; 2. Stablize hemodynamics; 3. Prevent arrhythmias; 4. Try to decrease the bleeding or oozing from the surgery.