摘要
目的对非体外循环下冠脉旁路术(OPCAB)的麻醉方法和效果进行总结和探讨.方法回顾分析1997年1月～2005年3月间连续实施的OPCAB麻醉543例,多数患者心功能差并伴有其他器官功能不全.麻醉诱导采用咪唑安定0.05～0.12mg/kg、氯胺酮0～0.5mg/kg和芬太尼5～15μg/kg,麻醉维持采用以0.3%～1.5%异氟醚和1～3mg/(kg·h)异丙酚,术中随手术操作出现血流动力学的骤然变化时,应用血管活性药物及时进行处理.结果麻醉效果满意,术中血压心率调控基本稳定.本组患者苏醒时间为术后2.3±0.8h,拔管时间为术后5.8±1.6h.ICU停留时间0.5～2.0天,术后8.0±1.2天出院.无脑血管意外、心肌梗死等并发症.术后住院死亡2例.结论对于OPCAB麻醉,合理应用麻醉药物和血管活性药物维持循环稳定,对于保证手术实施和患者安全至关重要.
Objective To summarize the technique and evaluate the effect of anesthesia for off-pump coronary artery bypass surgery （OPCAB）, Methods From 1997 through March of 2005, five hundred and forty-three consecutive patients undergoing OPCAB were retrospectively studied. Anesthesia was induced with midazolam 0. 05 -0. 12mg/kg, ketamine 0-0. 5mg/kg and fentanyl 5 - 15μg/· kg. Anesthesia was maintained with isoflurane 0. 3%-1.5% and oxygen, combined with propofol 1-3mg/（kg· h）. Intraoperative hypotension resulting from either surgical procedure or anesthetics should be dealt with inotropes immediately. Results Intraoperative hernodynarnics deviation was tolerated with the support of inotropics. The mean extubation time was 5. 8±1.6h. The ICU stay was 0. 5 to 2.0 day. The patients were discharged in 8. 0±1.2 days. Two patients met sudden death in the second postoperative day. Conclusion Rational use of anesthetics and inotropics to stabilize hemodynamics during operation plays a key role in successful OPCAB.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2005年第8期675-677,共3页
Medical Journal of Chinese People's Liberation Army
