冠状动脉架桥术麻醉及围手术期处理

Anesthesia and perioperative management in coronary artery bypass

目的 :介绍 1997年 4月至 1999年 10月我院 180例冠脉架桥手术 (CABG)患者麻醉特点及处理原则。方法 :采用小剂量咪唑安定 ,阈下值氯胺酮 ,常规剂量芬太尼诱导 ,异氟醚、异丙酚持续镇静的麻醉方法 ,分析180例接受CABG手术的患者的临床资料及麻醉用药情况和术中血流动力学状况。结果 :本组麻醉诱导平稳 ,循环稳定 ,体外循环时间平均 115min ,升主动脉阻断时间平均 5 5min。围术期死亡率 0 6 % (1例死于鱼精蛋白过敏 )。患者术后清醒时间 46h ,拔管时间平均 14h。结论 :即使是在严重冠心病患者 ,采用多种小剂量镇静药及大剂量芬太尼诱导、维持的麻醉方法 ,能获得平稳的麻醉诱导和维持以及稳定的血流动力学状态 ,从而有效防止围手术期低血压和心律失常造成的心肌缺血和围手术期心肌梗死的发生。

Objective:To present the characters of the anesthesia and perioperative management for coronary artery bypass surgery.Methods:180 patients with severe coronary artery disease receive the coronary bypass surgery from April 1997 to October 1999. Anesthesia induction was performed by minimal doses of midazolam (0 05~0 06 mg/kg), under threshold dose ketamine (0 5 mg/kg), fentanyl (10~15 μg/kg) and vecurum 0 15 mg/kg. Isoflurane 0 5%~1 5% in oxygen and continued fentanyl up to 50 μg/kg was administed for maintance. After pump off minimal dosage of propofol was given until returning ICU. The patient′s clinical data, anaesthesia drugs used and hemodynamic situations were analyzed.Results:.With this methods we provide smooth induction and stable circulation during all operation procedure. The mean time of aortic close clamp was 55 min, and the cardiopulmonary bypass time was 115 min. Only one case died from allergy of protaming in our group with the mortality 0 6%. Postoperativly, the patient awoke time was 4~6 hours and the mean extubation time was 14 hours.Conclusion:Adopting this protocol in the patient received coronary artery bypass graft even with severe condition provided a smooth induction of anesthesia, maintance, stable hemodynamic responses and effective prevent low blood pressure and arrhythmia which is the main causes of the myocardial ischemia, infraction and death during peri operative time