高位胸段硬膜外麻醉下清醒病人的冠状动脉搭桥手术

Awake coronary artery bypass surgery under high thoracic epidural anesthesia

目的 了解在高位胸段硬膜外麻醉下避免全麻行非体外循环心脏跳动下冠状动脉搭桥手术的可行性。方法 硬膜外麻醉下对 2 5例清醒病人行非体外循环心脏跳动下冠状动脉搭桥手术 ,没有气管插管全麻 ,所有病人在手术前晚行硬膜外置管。结果 总共搭桥 71支 (1支 11例 ,2支 5例 ,3支 6例 ,4支 3例 )。除 1例因为术中出现室颤转为全麻和体外循环外 ,2 4例在硬外麻作为唯一麻醉下完成非体外循环心脏跳动下冠状动脉搭桥手术。除 2例行左胸小切口外其余行正中切口 ;其中 6例为再次手术 ;平均每例搭桥2 8支 ,没有手术死亡。术后在复苏室和病房住院时间分别为 (16 2± 4 2 )h和 (3 2 4± 1 2 )d。结论 本组的早期经验提示在没有气管插管全麻。

Objectives To test the feasibility of the use of high thoracic epidural anesthesia as a sole anesthesia in patients undergoing off pump coronary artery bypass surgery, avoiding general anesthesia. Methods Twenty five cases underwent beating heart coronary artery revascularization without endotracheal general anesthesia, between October 2002 to April 2003, using high thoracic epidural anesthesia and analgesia. All the patients underwent epidural catheterization on the evening before the surgery. Results The patients in all received 71 grafts (single n =11, double n =5, triple n =6, quadruple n =8). Six patients underwent repeat coronary artery bypass. All except 1 patient underwent off pump coronary artery bypass graft surgery under high thoracic epidural anesthesia, 2 patients underwent grafting via left thoracotomy (MIDCAB) and the rest through mid stemotomy. One was converted to general anesthesia and cardiopulmonary bypass, there was no mortality. Mean length of stay in the intensive care unit was (16 2±4 2) hours and hospital was (3 0±1 2) days. Conclusion Our early experience confirms the feasibility of performing multiple coronary artery bypasses in conscious patients without endotracheal general anesthesia