精准心脏麻醉对成年人心脏外科手术安全性及有效性探讨  

The effectiveness and safety of precision cardiac anesthesia in patients undergoing cardiac surgery

作　　者：高宇晨 王春蓉[1] 王越夫[1] 杜娟[2] 向玲 王苏德娜 田宇 Gao Yuchen;Wang Chunrong;Wang Yuefu;Du Juan;Xiang Ling;Wang Sudena;Tian Yu(Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China;Department of Adult Intensive Care Unit, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China;Department of Anesthesiology, the Second People′s Hospital of Yibin, Yibin 644000, China)

机构地区：[1]中国医学科学院,北京协和医学院,阜外医院麻醉中心,100037 [2]中国医学科学院,北京协和医学院,阜外医院成人术后恢复中心,100037 [3]宜宾市第二人民医院麻醉科,644000

出　　处：《国际麻醉学与复苏杂志》2019年第8期749-753,共5页International Journal of Anesthesiology and Resuscitation

基　　金：阜外医院特色学科发展专项基金.

摘　　要：目的探讨精准心脏麻醉方案的有效性及安全性。方法纳入80例在全身麻醉下行择期心脏外科手术的患者,纽约心脏病学会(New York Heart Association, NYHA)心功能分级Ⅰ~Ⅳ级,采用完全随机法分为精准心脏麻醉方案组(P组)和传统麻醉方案组(C组),每组40例。P组采用以小剂量舒芬太尼为主,同时联合靶控输注精确调控患者血药浓度,BIS监测全身麻醉深度,指导合理化使用全身麻醉药物;根据患者术前、术中情况决定术后拔出气管导管的时机。C组采用常规剂量舒芬太尼麻醉方法,术毕患者带气管导管入ICU。分别记录两组患者术前基本资料,术中舒芬太尼用量、CPB例数、手术时间、最低体温等,术后机械通气时间、并发症发生情况、ICU停留时间、术后住院时间及住院费用等。结果P组术中舒芬太尼用量明显少于C组(P<0.05);C组患者术后肺炎发生率明显高于P组(P<0.05);P组术后机械通气时间、ICU停留时间及术后住院时间均明显短于C组(P<0.05);P组患者总住院费用和检查费用均明显低于C组(P<0.05)。结论精准心脏麻醉方案可安全、有效地用于成年人心脏外科手术,该方案减少患者ICU停留时间及术后住院时间,降低住院费用,提高医疗资源利用率。Objective To investigate the effectiveness and safety of precision cardiac anesthesia. Methods A total of eighty subjects[New York Heart Association(NYHA) grades Ⅰ-Ⅳ] undergoing selective cardiac surgery were enrolled. They were randomly divided into two groups (n=40): a precision cardiac anesthesia group (group P) and a conventional cardiac anesthesia group (group C). Group P was primarily administrated with a low-dose of sufentanil, in combination with target - controlled infusion to accurately adjust the blood concentration of anesthetics as well as bispectral index to monitor anesthesia depth. The aim of this protocol of precision cardiac anesthesia was to achieve the rationalization of anesthetic use. The timing of tracheal extubation following cardiac surgery was determined by pre- and intra-operative individual general condition in group P. Routine dosage sufentanil was traditionally administrated in group C, and patients were transferred to intensive care unit (ICU) with tracheal intubation after surgery. All patients′ data were recorded including baseline characteristics, intraoperative sufentanil dosage, cases with cardiopulmonary bypass(CPB), operation time, lowest temperature, duration of mechanical ventilation, poor events, ICU length of stay, post - operative hospitalization stay and cost of hospital care. Results The total amount of sufentanil used intra-operatively was significantly less in group P than that in group C (P<0.05). The number of patients developing pneumonia after surgery in group C was revealed to be significantly greater than that in group P (P<0.05). Compared to group C, patients in group P had significantly decreased length of mechanical ventilation, ICU stay and post - operative hospital stay (P<0.05). Both total hospital expenditure and medical examination fee were significantly less in group P (P<0.05). Conclusions Precision cardiac anesthesia is of effectiveness and safety in adults undergoing cardiac surgery. It can reduce ICU and post-operative hospitalization stay. I

关 键 词：心脏手术 精准心脏麻醉 快通道 

分 类 号：R614[医药卫生—麻醉学]