非体外循环冠状动脉搭桥术的麻醉管理_论文.docxVIP

非体外循环冠状动脉搭桥术的麻醉管理 关键词：非体外循环 【摘要】 目的 探讨非体外循环下冠状动脉搭桥术病人的围术期管理及术后拔管。方法 择期非体外循环下冠状动脉旁路移植术病人68例,采用异丙酚、芬太尼、维库溴铵、安氟醚等静吸复合全麻。硝酸甘油、佩尔地平、艾司洛尔、去氧肾上腺素、多巴胺、多巴酚丁胺等用于调控血流动力学指标。观察术后清醒时间、拔管时间和入住重症监护室（ICU）时间。结果 所有病人的清醒时间、拔管时间和入住ICU时间分别为(78±42)min、（±）h、（±）h。术毕62例病人在4h内拔管。66例预后良好,无麻醉并发症。结论 施行“快通道”心脏麻醉有利于术后早期拔管,减少病人在 ICU的停留时间。非体外循环下冠状动脉搭桥术麻醉管理的关键是维持血流动力学平稳和心肌氧供与氧耗的平衡。 【关键词】 非体外循环冠脉搭桥术；麻醉；管理 Anesthetic management and tracheal extubation of patients undergoing off-pump coronary artery bypass grafting(OPCABG) 【Abstract】 Objective To investigate the anesthetic management and tracheal extubation of patients undergoing off-pump coronary artery bypass grafting. Methods 68 patients underwent off-pump coronary artery bypass grafting were anesthetized with propofol, fentanyl, vecuronium combined with anflurane. nitroglycerin, perdipine, esmolol, Phenylephrine， dopamine, dobutamine were used to control patients hemodynimics. Consciousness recovery time, tracheal extubation time and stay in intensive care unit (ICU )time were All patients consciousness recovery time, tracheal extubation time and stay in ICU time were 78±42min,± hours,± hours. Tracheal intubation were remained 4 hours in 62 patients after operation, 66 patients had good recovery without any anesthesia Administration of FTCA benefits early tracheal extubation after operation and shortens the stay in ICU. The key of perioperative management of patients undergoing off-pump coronary artery bypass grafting depends on the maintenance of hemodynamics stability and the equilibrium between myocardial oxygenic supply and oxygenic consuming. 【Key words】 off-pump coronary artery bypass grafting; anesthesia; management 非体外循环下冠状动脉搭桥术(Off-pump coronary artery bypass grafting, OPCAB),由于不需体外循环,减轻了对患者的生理干扰,术后并发症少,恢复快,费用降低,而成为目前冠心病手术治疗的一种重要选择［1,2］。此类手术在心脏跳动下进行血管吻合,术中血流动力学波动大,吻合血管期间会造成心肌缺血,故对麻醉技术提出了很高的要求［3］。本文结合68例此类手术的临床麻醉,探讨其术中管理、术后拔管经验。 1 临床资料 一般资料 本组患者68例，男45例，女23例；年龄45～75岁，平均岁。术前