非体外循环下冠状动脉搭桥术的麻醉管理

Anesthetic management of patients undergoing off-pump coronary artery bypass grafting

目的 :总结 2 8例非体外循环下多支冠状动脉搭桥术的麻醉管理。方法 :术前依据患者心脏功能及全身状况 ,给予营养心肌、扩冠、降压、利尿等治疗。采用静吸复合麻醉 ,气管插管控制呼吸 ,在非体外循环下行冠状动脉搭桥术。结果 :手术期间 4例血压过低 ,2例 ST段显著抬高伴室性心律失常 ,改为体外循环辅助下手术 ,余 2 2例术中血流动力学平稳。术毕非体外循环组 2 2例 6～ 8h内拔管 ,明显少于体外循环组 (10～ 16h)。 2 8例预后良好 ,无麻醉并发症。结论 :维持血流动力学平稳和心肌氧供需平衡 。

AIM: To summarize anesthetic management for 28 patients undergoing cardiac surgery with multiple coronary artery bypass grafts without cardiopulmonary bypass. METHODS: According to preoperative cardiac function and general status of patients, therapy such as myocardial nutrition management, expansion of the coronary artery, depressor and diuresis were taken. Off pump coronary artery bypass grafting (OPCAB)was performed on all patients under intravenous inhalant anesthesia. Tracheal intubation was performed for mechanical ventilation during anesthesia. RESULTS: Low blood pressure(4 cases), downward shift of the ST interval and ventricular arrhythmia(2 cases) were found during operation. The above operations were continued with the aid of cardiopulmonary bypass. The hemodynamics of the remained 22 cases were steady. Tracheal intubation were remained 6～8 hours in 22 patients of OPCAB group after operation, much less than those in CAB group(10~16 h). All cases had good recovery without any anesthesia complications. CONCLUSION: To maintain hemodynamic stability and keep the balance of supply and consumption of oxygen in heart are the key to the anesthesia for off pump coronary artery bypass grafting.