摘要:目的: 探討非體外循環冠狀動脈旁路移植術(offpump coronary artery bypass grafting,OPCABG)患者的圍術期管理。 方法 : 回顧分析2005 年7 月至2008 年6 月的200 例擇期非體外循環下冠狀動脈旁路移植術患者200例,誘導用咪唑安定005～01 mg/kg,依托咪酯03 mg/kg,芬太尼5～15 μg／kg,羅庫溴銨05～10 mg／kg,麻醉維持采用持續泵注異丙酚1～4 mg/kg·h,,間斷輔以05%～20%異氟烷吸入,術中隨手術操作時出現的血流動力學變化,用血管活性藥物調整。 結果 : 麻醉效果滿意,術中血壓心率基本滿意。本組患者蘇醒時間,拔管時間和ICU停留時間為(178±42) min、(105±40)h、(18±63)h。術畢180例患者在12 h內拔管。180例預后良好,無麻醉并發癥。 結論 :非體外循環下冠狀動脈旁路移植術麻醉管理的關鍵是合理的應用麻醉藥和血管活性藥來維持血流動力學平穩。Abstract: Objective: To summarize the technique and evaluate the effect of anesthesia for offpump coronary artery bypass surgery (OPCAB). Methods :From July of 2005 through June of 2008,two hundred consecutive patients undergoing OPCAB were retrospectively studied. Anesthesia was induced with midazolam 00501mg/kg, or etomidate 03mg/kg and fentanyl 515μg/kg. Anesthesia was maintained with isoflurane 05%20% and oxygen, combined with propofol 14mg/(kg·h). Intraoperative hypotension resulting from either surgical procedure or anesthetics should be dealt with inotropes immediately. Results :Intraoperative hemodynamics deviation was tolerated with the support of inotropics. The mean of patients of consciousness recovery time, tracheal extubation time and stay in ICU time were 178±42 min,105±40 hours and 18±63 hours. The patients were discharged in 80±12 days. Racheal intubation were remained 12 hours in 180 patients after operation, 180 patients had good recovery without any anesthesia complications. Conclusion : Rational use of anesthetics and inotropics to stabilize hemodynamics during operation plays a key role in successful OPCAB.
