非体外循环下冠脉搭桥术的麻醉处理  

Anesthesia management of off - pump cornonary artery bypass gliffting

作　　者：李莉[1] 刘怀萍[1] 黄卫[2] 

机构地区：[1]汕头大学医学院第二附属医院麻醉科,515041 [2]广东省人民医院心血管病研究所麻醉科

出　　处：《中国实用医刊》2009年第13期4-5,共2页Chinese Journal of Practical Medicine

摘　　要：目的探讨非体外循环下冠脉搭桥术适宜的麻醉方法。方法收集拟行非体外循环下冠脉搭桥术的患者43例，入手术室后在异丙酚2mg／kg、维库溴铵0．15mg／kg、芬太尼5～10μg／kg诱导下进行气管插管，术中监测脉搏氧饱和度（SpO2）、心电图（ECG）、桡动脉有创测压、肺动脉压、肺毛细血管嵌顿压、中心静脉压、呼气末二氧化碳分压，麻醉维持采用异丙酚和瑞芬太尼混合液，维库溴铵静脉泵注。整个手术过程中，持续泵注硝酸甘油0．25～0．5μg／（kg·min），根据血压和心率酌情静注去氧肾上腺素2～4μg／kg或艾司洛尔0．2—0．4mg／kg。结果所有患者麻醉手术过程平稳，血流动力学稳定，安全度过麻醉手术期。结论术中保持适当的麻醉深度，维持和改善心肌的氧供需平衡，是非体外循环下冠脉搭桥术麻醉管理的关键。同时，合理应用正性肌力药物和血管扩张药物，保持充足的循环血容量，保证血红蛋白和血细胞比客的质和量，适度的术后镇痛是安全度过围术期的有利措施。Objective To summarize the anesthesia management of off - pump cornonary artery bypass gliffing（OPCABG）. Methods Forty - three patients undergoing OPCABG propofol 2 mg/kg, vencuronium 0.15 mg/kg,fentanyl 5 - 10 μg/kg were given, then performed intubation, SpO2, IAP, ECG, PAP, PCWP, CVP, EtCO2 were monitered continuously. During the operation, phenylephrideine and nitroglyceriym were administrated to control blood pressure, esmolol to assist heart rate, in order to maintain anesthesia, propofol - remifentanyl mixture and vencuronium were given. Results All anesthesia was successful with steady induction, the hemodynamics was kept stable. Conclusions It is important to keep the hemodynamics stable, proper administration of inotropic agent and angiotenie for the blanee of myocardial oxygennous supply and demand. Meantime, to keep the signigicant of circulatic volume, provide a good quality of Hct and Hb, post - operative analgesia are good for the patients to passed through the peri - operation.

关 键 词：非体外循环 冠脉搭桥术 麻醉 

分 类 号：R614[医药卫生—麻醉学]