非体外循环下冠状动脉搭桥术的麻醉管理

目的：分析非体外循环冠状动脉搭桥术（OPCAB）中血流动力学的变化及麻醉处理特点。方法：回顾分析50例冠心病患者择期行OPCAB，均采用咪唑安定、芬太尼、依托咪酯和罗库溴铵诱导，芬太尼、维库溴铵复合七氟醚静吸复合麻醉。术中根据血流动力学变化调整体位和运用血管活性药物。结果：全组病例均成功完成手术，术中生命体征平稳，1例在ICU再次发生急性心肌梗死，经过积极抢救痊愈出院，其余无并发症顺利康复。结论：OPCAB手术时合理运用麻醉药物和血管活性药物，合理运用体位的变化，维持血流动力学的稳定与心肌的氧供需平衡，对于保证手术的顺利进行和患者的安全至关重要。

Anesthesia Management in Off-pump Coronary Artery Bypass

Objective：To analyze the hemodynamic changes and characteristics of anesthesia in off-pump coronary artery bypass（OPCAB）. Method：The clinical data of 50 patients with coronary heart disease were retrospectively analyzed,and all patients chose to undergo OPCAB,and all patients received induction with midazolam,fentanyl,and rocuronium bromide,and all patients received intravenous inhalational anesthesia with fentanyl,vecuronium bromide,and sevoflurane. According to intraoperative hemodynamic changes the position was adjusted,and vasoactive drugs were used. Result：All the patients successfully completed surgery,and intraoperative vital signs of patients were stable,and 1 case happened acute myocardial infarction again in ICU,and this patient recovered through active rescue,and the rest of patients didn’t have complication and recovered smoothly. Conclusion：Some measures are very important to ensure the smooth progress of the operation and the safety of patients,including using narcotic drugs and vascular active drugs in OPCAB reasonably,and using the change of position rationally,and maintaining stable hemodynamics and the supply and demand of myocardial oxygen in balance.