布瑞亭用于非体外循环冠状动脉旁路移植患者超快通道麻醉临床研究

Clinical Study on the Application of Bretin in Super-fast Track Anesthesia of Patients Undergoing off-pump Coronary Artery Bypass Grafting

目的对比观察采用以减少阿片类用药的平衡麻醉和以术后即刻拮抗肌松残余为核心的麻醉方法探索非体外循环冠状动脉旁路移植手术(OPCABG)患者超快通道麻醉技术,并评价其有效性和安全性。方法50例拟行非体外循环冠状动脉旁路移植手术患者,纽约心功能分级Ⅰ~Ⅲ级,随机分为两组:常规麻醉组和超快通道麻醉组(UFTA组),每组25例。常规麻醉组采用传统心脏手术麻醉方案,UFTA组采用减少阿片类用药的平衡麻醉,并于术毕即刻应用布瑞亭拮抗残余肌松作用,待患者意识恢复,自主呼吸恢复良好,咳嗽吞咽反射恢复,血流动力学平稳无其他手术相关急症,于术后即刻或ICU 12 h内完成气管导管拔除,并在病情平稳后搬出ICU。观察并对比两组术后情况(拔管时间、ICU驻留时间、住院时间、首次经口进食水时间、血管活性药支持时间)、不良事件发生率以及患者的满意度。结果UFTA组术后拔管时间、ICU驻留时间、术后住院时间、血管活性药支持时间及第1次经口进食水的时间均显著少于常规麻醉组(P<0.05)。UFTA组和常规麻醉组患者术后不良事件发生率无显著性差异(P>0.05),但UFTA组患者满意度明显较常规麻醉组高(P<0.05)。结论采用布瑞亭即刻拮抗肌松的超快通道麻醉技术可以安全有效的用于非体外循环冠状动脉旁路移植手术,有利于此类患者的术后快速康复。

Objective To compare and observe the balanced anesthesia with opioid reduction and the anesthesia with immediate postoperative antagonism of muscle relaxation residue as the core,to explore the super-fast channel anesthesia technique in patients undergoing off-pump coronary artery bypass grafting,and to evaluate its effectiveness and safety.Methods Fifty patients undergoing off-pump coronary artery bypass grafting were randomly divided into two groups:routine anesthesia group and ultra-fast channel anesthesia group(UFTA group),with 25 patients in each group,according to new york cardiac function gradeⅠ-Ⅲ.The routine anesthesia group adopted the traditional anesthesia scheme for cardiac surgery.UFTA group was treated with balanced anesthesia to reduce opioid use,and brexitin was used to antagonize residual muscle relaxation immediately after the operation.After the patient's consciousness recovered,his spontaneous breathing recovered well,his cough and swallowing reflex recovered,and his hemodynamics was stable without any other emergency related to the operation,the tracheal catheter was removed immediately after the operation or within 12 hours in ICU,and the patient was moved out of the ICU after the condition was stable.The postoperative conditions(postoperative extubation time,ICU stay time,hospitalization time,first oral intake and water time,vasoactive drug support time),incidence of adverse events and patient satisfaction were observed and compared between the two groups.Results The postoperative extubation time,ICU stay time,postoperative hospital stay,vasoactive drug support time,and the first oral water intake time in the UFTA group were significantly shorter than those in the conventional anesthesia group(P<0.05).There was no significant difference in the incidence of postoperative adverse events between the UFTA group and the conventional anesthesia group(P>0.05),but the patient satisfaction in the UFTA group was significantly higher than that in the conventional anesthesia group(P<0.05).Conclusion The ultrafast-track anesthesia technique using britin to immediately antagonize muscle relaxation can be safely and effectively used in off-pump coronary artery bypass grafting,which is beneficial to the rapid postoperative recovery of such patients.