心脏瓣膜置换复合冠状动脉搭桥手术病人的麻醉处理

Anesthetic management of patients undergoing valvular replacement and coronary artery bypass grafting

目的 总结 6例冠状动脉搭桥与同期施行心脏瓣膜置换术的麻醉处理特点。方法 6例冠心病合并心脏瓣膜功能不全 ,均在全麻体外循环下同期施行冠状动脉搭桥和心脏瓣膜置换术。麻醉采用芬太尼为主的静吸复合全麻。麻醉开始后静滴GIK溶液以改善心肌功能。术中应用微量泵静注硝酸甘油、多巴胺维持血流动力学的稳定。结果 麻醉诱导及体外循环前血流动力学平稳 ,无心肌缺血表现。停止体外循环后未发生低心排综合征 ,均恢复良好。

Objective To retrospectively review the experience of anesthesia for 6 patients undergoing combined cardiac valvular replacement and coronary artery bypass grafting operation. Methods Anesthesia was induced with midazolam and fentanyl, and maintained with moderate dose fentanyl and supplement with propofol and isoflurane. An intravenous infusion of nitroglycerin and dopamine were given for achieving hemodynamic stability during the operation. The glucose insulin potassium solution was given intravenously at 5 ml/kg after induction of anesthesia. Results There were no significant changes in any hemodynamic variables during the induction and pre CPB. After CPB low cardiac output syndrome did not appeared in all patients. There was no mortality in this group and all patients were discharged with improved heart function. Conclusion This results suggest that fentanyl propofol isoflurane anesthesia is an acceptable technique for combined cardiac valvular replacement and coronary artery bypass grafting operation.