非体外循环冠状动脉旁路移植术的麻醉处理

Anesthesia for patients underwent off-pump coronary artery bypass grafting

目的 探讨非体外循环冠状动脉旁路移植术的麻醉处理。方法 12例行非体外循环冠状动脉旁路移植术患者 ,采用咪哒唑仑、芬太尼、异丙酚、安氟醚 (异氟醚 )、维库溴铵复合全麻 ,诱导后持续应用硝酸甘油 ,并应用艾司洛尔、去氧肾上腺素等药物维持血流动力学稳定和心肌氧供需平衡。结论 11例麻醉手术顺利 ,1例危重患者术中发生严重循环紊乱 ,改在体外循环下完成手术 ,但不能脱离体外循环机 ,死亡。结果 术前正确判断左心室功能、采用避免抑制心肌功能的麻醉药物、严密监测心血管功能、术中维持心肌氧供需平衡并正确处理糖尿病等合并症 ,是手术成功的关键。对于左心室功能严重受损者 ,建议在体外循环下手术。

Objective To discuss the anesthesia for patients unde rwent off0pump c oronary artery bypass grafting (OPCABG) Methods Twelve patients with co ronary artery disease (CAD) were received OPCABG u nder midazolam0fentanyl0propofol0enf lurane(isoflurane)0vecuronium general ane sthesia After induction, nitrog lycerin(NTG) was dripped continuous ly,an d esmolol or phenylephrine was given if need ed to maintain stable cardiovascular functio n and myocardial oxygen supply0demand balance Results Eleven cas es were s uccessful One patient died from severe c ardiovascular collapse when left internal mammary artery and left anterior desce nding arterry(LAD) anastomosis even cardio pulmonary bypass(CPB) establish ed and CABG finished Conclusions Making left ventricle(LV) function eval uation preoperatively,using anesthetics th at no inhibitory influence on myocardi al function,monitoring cardiovascular fun ction closely,and maintaining myocard ial oxygen supply0demand balance are very imp ortant to OPCABG If LV function is severely damaged,CPB is the best choic e