冠心病患者一站式杂交手术的麻醉处理

目的 分析冠心病患者一站式杂交手术的麻醉管理经验和相关问题.方法 2007年7月至2009年6月北京阜外医院63例冠心病一站式杂交手术患者,先行小切口不停跳的乳内动脉到前降支的搭桥手术,术后即刻造影确认乳内动脉搭桥是否通畅,随后行冠状动脉介入治疗.术中连续监测有创血压、五导联心电图、中心静脉压(CVP)、脉搏血氧饱和度、体温等.诱导和维持宜采用小剂量阿片类药物为主的静吸复合麻醉方案,并且根据手术需要采取特定的抗凝方案.结果 术中血流动力学稳定,出血少,术后机械通气时间短;利用快通道技术实施术毕即刻拔管6例;围术期无一例患者死亡.结论 该类手术具有的微创特性对循环的影响小,单纯麻醉管理的难度不大,注意术中需要采取特殊的抗凝方案.快通道技术的实施可以进一步体现该类手术的优势.

Anesthetic management for 1-stop hybrid revascularization of coronary artery disease

Objective To summarize the anesthesia managements on 63 CAD patients undergoing 1-stop hybrid revascularization from July 2007 to June 2009 in Fuwai Hospital Methods ECG, direct BP, SpO2, PET CO2, CVP and body temperature were monitored during anesthesia. The management of intraoperative anesthesia should preferably use a small dosage of opioids with inhalation or intravenous anesthesia. At the same time , specific anticoagulation management was administered. Results The hemodynamics were stabilized. the time of tracheal intubation were shorter. 6 patients were immediate extubated in the operating room with application of fast-track technology. No patient died. Conclusions Such minimally invasive surgery has little effect on the circulation. The difficulty of anesthetic management is smaller. Specific anticoagulation management is administered. Implementation of the Fast-track technology can demonstrate the further advantages in such surgery.