非体外循环冠状动脉旁路移植术麻醉中的循环管理

The circulatory management in anesthesia for patients undergoing off-pump coronary artery bypass grafting

目的 探讨非体外循环冠状动脉旁路移植术 (OPCABG)麻醉的循环管理。方法 在大剂量芬太尼静脉麻醉下 ,对 10例多支冠脉病变的冠心病患者实施OPCABG ,系统观察术中患者循环变化的规律和特点 ,并根据手术需要进行血流动力学调控。结果 手术进行顺利 ,麻醉经过平稳 ,虽手术操作引起血流动力学变化 ,但无一例改为体外循环下手术 ,循环控制满意。结论 非体外循环冠状动脉旁路移植术麻醉的循环管理 ,关键在于尽可能减少心肌氧耗 ,维护心肌的血流供应 。

Objective To inves tigate t he circulatory management in anesthesia for patients undergoing off-pump coronar y artery bypass grafting (OPCABG).?Methods The ten pati ents undergoing OPCABG were anesthetized with large doses of fentanyl. Their cir culatory conditions during the operation were monitored and manipulated accordin g to the need of the operative procedures.?Results The operations were performed smoothly under stable anesthesia. Although there were hemodynamic fluctuations, owing to the successful management of circulation, in no case was the off-pump plan forced to be shifted to CABG with CPB.?Conclusion The key to circulatory management in anesthesia for pat ients undergoing OPCABG is reduction of cardiac oxygen consumption, adequate sup ply of coronary blood flow, and reasonable adjustment of circulation.