冠状动脉搭桥的麻醉处理

目的探讨冠状动脉搭桥麻醉处理要领.方法体外循环与手术:应用浅-中低温体外循环,血管桥用大隐静脉、左乳内动脉.麻醉:选择咪唑安定、芬太尼、维库溴胺复合麻醉.监测血液动力学指标、动脉血气等.围术期应用正性肌力药、血管加压/扩张药.结果冠状动脉搭桥9例,麻醉、体外循环、手术顺利;体外循环时间平均为116.7min、主动脉阻断平均为76.1 min;平均每例搭桥3.7根.围术期应用多巴胺、硝酸甘油、艾司洛尔、米力农等维持心功能、血液动力学平稳;血气、电解质等指标在正常范围.结论冠状动脉搭桥的麻醉处理在于选择对心肌氧供/氧耗平衡影响较小的麻醉药物、维持适当的麻醉深度和适时、适量应用正性肌力药、血管加压/扩张药、抗心律失常药,维持血液动力学稳定.

Anesthesia for coronary artery bypass graft surgery

Objective To investigate the methods of anesthesia for coronary artery bypass graft surgery (CABG). Methods 9 patients for elective CABG under hypo-middle-thermic cardiopulmonary bypass (CPB) were enrolled in the study.Internal mammary artery (INA) and great saphenous vein were used for conduits.Midazolam,fentanyl,vecuronium were administered for general anesthesia and vasoactive medication and vasodilating agent for keeping hemodynamic stability.Hemodynamic measurements and artey blood gas analysis were performed perioperatively. Results Anesthesia,CPB and Surgery were performed unevenfully.The average CPB time was 116.7minutes and aortic clamping tim was 76.1minutes.Bypass grafting conduits were 3.7 per case.Vasoactive medication and vasodilating agent such as dopamine,nitroglycrin,esmolol,milrinone were administered for maintenance of stable hemodynamics.Measurements for artery blood gas analysis and electrolytes were normal perioperatively.No remarkable adverse effect was noted in the study. Conclusions It'svery important for anesthesia for coronary artery bypass graft surgery to selectanesthetic agents which produced less disruption of the normal balance of myocardial oxygen supply and demand,to keep suitable depth of anesthesia,to administervasoactive medication,vasodilating agent and antiarrhythmic agents properly. Anesthesia;Cardiopulmonary bypass;Coronary artery bypass graft surgery