全麻对非体外循环冠状动脉旁路移植术患者血流动力学与氧代谢的影响  

Effect of general anesthesia on hemodynamics and oxygen metabolism in patients with off pump coronary artery bypasses grafting

作　　者：孙立智[1] 吴智宏[1] 李霞[1] 马红梅[1] 王飞[1] 魏赞 张虎[1] 宗葆熹 

机构地区：[1]北京电力医院,北京100073

出　　处：《现代中西医结合杂志》2016年第3期251-253,共3页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的观察全麻对非体外循环冠状动脉旁路移植术患者血流动力学与氧代谢指标的影响。方法选择择期行非体外循环冠状动脉旁路移植术治疗的患者56例,监测开胸后(t1)、暴露和固定前降支后(t2)、暴露和固定回旋支后(t3)、暴露和固定右冠状动脉后(t4)、关胸(t5)5个时间段血流动力学指标以及氧代谢指标变化情况,观察术前及术后3个月、6个月患者生活质量。结果患者均按照计划完成手术,无失访现象。与t1比较,t2时m PAP、PVR均增加,MAP、CI降低;t3时HR、CVP、m PAP、PAWP、SVR、PVR均增加,MAP、CI降低;t4时HR、CVP、m PAP、SVR、PVR均增加,MAP、CI则降低;t5时HR、MAP、m PAP均增加,CI降低,差异均有统计学意义(P均<0.05)。t3与t5时D(O2)均明显低于t1时(P均<0.05),t3时ER(O2)明显高于t1和t5时(P均<0.05)。随访3个月、6个月患者的生活质量指标PF、RP、RE得分均明显高于术前(P均<0.05)。结论全麻有助于改善非体外循环冠状动脉旁路移植术患者的血流动力学与氧代谢指标,提高术后患者的生活质量。Objective It is to observe the influence of general anesthesia on hemodynamics and oxygen metabolism changes in patients with off pump coronary artery bypasses grafting. Methods 56 patients who were adopted off pump coronary artery bypasses grafting operation were selected, and their hemodynamics indexes and oxygen metabolism changes were observed at open chest （t1） , exposure and fixed anterior descendens （ t2 ） , exposure and fixed circumflex branch （ t3 ） , exposure and fixed right coronary artery （ t4 ） , close chest （ t5 ）. Their lives qualities were evaluated before and after operation of 3 - and 6 - month. Results All patients were completed the operation by schedule, No loss of follow-up cases, compared with t1 , mPAP and PVR were obviously increased at t2, but MAP and CI were obviously decreased; HR, CVP, PAWP, mPAP, SVR, PVR were obviously increased at t3 , but MAP and CI were obviously decreased; HR, CVP, mPAP, SVR, PVR obviously increased at t4, but CI and MAP were obviously decreased; HR, MAP, mPAP were obviously increased at t5 , but CI was obviously decreased ; there were significant differences （ all P 〈 0.05 ）. D （ O~ ） at tl was obviously decreased at t3 and ts （ all P 〈 0.05 ） , ER（ 02 ） at t3 was obviously increased at t1 and t5 （ all P 〈 0.05 ）. Followed up for 3 - and 6 - month, patients＇ lives qualities indexes as PF, RP, RE scores were obviously increased than after operation （ all P 〈 0. 05 ）. Conclusion general anesthesia will be helpful for improve hemodynamics and oxygen metabolism changes in patients with off pump coronary artery bypasses grafting, and increase patients＇ lives qualities.

关 键 词：非体外循环冠状动脉旁路移植术 全麻 血流动力学 氧代谢 生活质量 

分 类 号：R614.2[医药卫生—麻醉学]