非体外循环下冠状动脉旁路移置术的麻醉管理

Anesthesia management of 10 patients undergoing off-pump coronary artery bypass

目的 :总结非体外循环冠状动脉旁路移置术 (OPCAB)的麻醉管理要点。 方法 :10例患者行OPCAB ,用SWAN GANZ导管监测术中和术毕血流动力学变化。 结果 :10例患者术后均存活。前降支吻合血流动力学指标无变化 ,右冠状动脉吻合时血流动力学有轻度改变 ,旋支及对角支吻合时 ,平均肺动脉压 (MPAP)、中心静脉压(CVP)、肺毛细血管楔压 (PCWP)明显升高 ,心排血指数 (CI)降低 ,手术毕CI明显升高。 结论 :OPCAB优点明确 ,冠状动脉各分支的手术对血流动力学有不同影响 。

Objectives: To get experience of anesthesia management of off pump coronary artery bypass(OPCAB). Methods: Ten patients undergoing OPCAB were analysed hemodynamic changes during and after operation with SWAN GANZ catheter. Results:All of the 10 patients survived.There were no hemodynamic changes during LAD anastomosis.Only slight hemodynamic changes during RCA anastomosis.Hemodynamic changed significantly during Cx and D anastomosis with marked elevation of MPAP,CVP,PCWP and marked decrease of CI.CI increased markedly after operation. Conclusions:It is definite that OPCAB is superior than cornary artery bypass under CPB.Anesthesiologists should be familiar with the different hemodynamic changes during the different periods of the operation.