非体外循环冠状动脉旁路移植术25例血流动力学变化及麻醉方法分析

Hemodynamic Changes during Off-pump Coronary Artery Bypass Graft Surgery and Anesthetic Management

目的:评估非体外循环冠状动脉旁路移植术(OPCABG)中血流动力学变化。方法:随机选择25例,在OPCABG期间连续监测心率(HR)、平均动脉压(MAP)、平均肺动脉压(MPAP)、混合静脉血氧饱和度(SvO_2)、中心静脉压(CVP)和心排血量(CO)的变化。记录心脏固定器释放前吻合各支血管期间的血流动力学变化以及血管吻合前(基础值)和全部吻合完毕后血流动力学变化。结果:患者平均年龄(63.4±8.5)岁,平均搭桥(2.8±0.9)支。吻合各支远端时,MAP、CO和 SvO_2与各自基础组比较显著性下降(P<0.05或P<0.01);CVP显著性上升(P<0.05或P<0.01);在吻合右冠状动脉(RCA)和左旋支(CX)期MPAP显著性下降(P<0.05);吻合近端时,除MAP外,其他参数的变化无统计学意义。结论:在OPCABG时,暴露和吻合远端血管,将引起心脏的移位和压迫致显著的血流动力学衰减,尤其见于CX和RCA.采取适当的措施,所有患者能很好地耐受这些血流动力学的变化。

Objective: To assess the patients' hemodynamics during off-pump coronary artery bypass graft (OPCABG) surgery. Methods: The heart rate(HR), mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), mixed venous oxygen saturation (SvCh), central veneous pressure(CVP) and cardiac output (CO) were continuously monitored in 25 patients with complete OPCABG revascularization. Hemodynamic changes were recorded at the completion of the anastomosis before releasing coronary snaring and stabilization and compared to baseline(before anastomosis). Results: The mean age of the patients was (63. ±8. 5) years, and on average (2. 8 ±0.9) grafts per patient were performed. The MAP, CO and Sv02 significantly decreased in all territories (P < 0. 05 or P < 0. 01). The CVP significantly increased in all anastomosed distal blood vessels. The MPAP significantly decreased in RCA and CX territories ( P < 0. 05). The patients' hemodynamics was of no statistical significance except MAP in anastomosed all proximal blood vessels. Conclusion: Cardiac displacement and compression induced by exposure and anastomosis of distal blood vessels during OPCABG surgery bring significant decline in the patients' hemodynamics , especially in RCA and CX territories . These haemodynamic changes were transient and well tolerated under anesthetic technique.