非体外循环冠状动脉旁路移置术的麻醉管理  

ANESTHETIC MANAGEMENT FOR OFF-PUMP CORONARY ARTERY BYPASS GRAFTING

作　　者：王世端[1] 袁莉[1] 江岩[1] 韩洪鼎[1] 王爱娟[1] 

机构地区：[1]青岛大学医学院附属医院麻醉科,青岛266003

出　　处：《齐鲁医学杂志》2003年第1期1-3,共3页Medical Journal of Qilu

摘　　要：①目的　评价非体外循环下冠状动脉旁路移置术 (OPCABG)的麻醉管理技术及其效果。②方法19例行OPCABG的病人 ,麻醉诱导后以微量泵持续静脉输注异丙酚、利多卡因复合液 ,并间断注射芬太尼和维库溴铵 (或哌库溴铵 )维持麻醉。用硝酸甘油、苯肾上腺素、艾斯洛尔 (或尼卡地平 )及多巴胺等血管活性药物调控心率、血压 ,维持理想的循环状态。手术全程监测动脉压、心电图、中心静脉压或 (和 )肺动脉楔压的变化 ,合理补充血容量。采用血液稀释自体输血与手术野血液回收相结合的血液保护技术。用肝素抗凝维持激活全血凝固时间大于 3 0 0s。维持正常体温。③结果　 2例因术中出现严重低血压并发室颤紧急改用体外循环下完成手术 ,另 17例麻醉手术经过顺利。旁路移置 1～ 2支 5例 ,3支 10例 ,4支 (或 4支以上 ) 4例。 11例未输异体血。术后机械通气时间 4～ 11h ,平均 ( 8.5± 3 .3 )h。无麻醉死亡。④结论　异丙酚、利多卡因复合液持续静脉输注 ,间断注射芬太尼和维库溴铵 (或哌库溴铵 )是OPCABG的理想麻醉技术 ,术中良好的循环调控是保证手术顺利进行的关键 。Objective To evaluate the effects of anesthetic management for off-pump coronary artery bypass grafting(OPCABG). Methods Nineteen patients undergoing OPCABG were anesthetized with complex anesthesia by continuous administration of intravenous propofol-lidocaine and intravenous bolus fentanyl and vecuronium (or pipecuronium). Nitroglycerine was used by continuous intravenous drip during the operation. Blood pressure and heart rate were adjusted to the level of 18.7-12.0/12.0-6.7 kPa and 50-75 min -1, respectively,by using dopamine, phenylephrine, nitroprusside and esmolol (or nicardipine) to maintain the hemodynamics as stable as possible . Heparin 1.0-1.5 mg/kg was injected intravenously to maintain the activated coagulation time(ACT) for longer than 300 s. Results The number of arteries for bypass grafting was 1-2 in 5 cases, 3 in 10 cases, 4 in 4 cases. Two out of the cases were changed to extracorporeal circulation due to very unstable hemodynamics. Eleven cases were not given allogenic blood transfusion. The postoperative ventilation duration was 4-11 h, averaging (8.5±3.3)h. There was no anesthesia-related death. Conclusion The combination of propofol with lidocaine iv continuously, and fentanyl-vecuromium iv intermittently is an ideal technique for OPCABG. The key point for success of the surgery is to control and adjust the circulation of patients, a comprehensive technique of blood protection may reduce transfusion of allogenic blood.

关 键 词：冠状动脉旁路移置术 非体外循环 麻醉 血流动力学 

分 类 号：R654.2[医药卫生—外科学]