冠状动脉主干重度狭窄搭桥术麻醉处理486例总结

目的:探讨冠心病冠状动脉主干重度狭窄患者,行搭桥术临床特点及围术期治疗措施。方法:我们对2001年1月至2010年10月,486例冠状动脉主干重度狭窄行搭桥术患者的麻醉及围术期治疗进行回顾性分析。结果:442例行非体外循环下冠状动脉搭桥术(OPCABG)。28例在体外循环下行冠状动脉搭桥术(CABG)。16例患者在OPCABG过程中,由于发生严重心肌缺血、心动过速及低血压,改为体外循环下完成手术。113例放置主动脉内球囊反搏(IABP),包括术前、麻醉前放置8例,麻醉后及术中放置78例,术后放置27例。死亡9例,发生在术后72 h内。结论:冠心病冠状动脉主干重度狭窄患者,围术期需要维持心率、血压平稳、合理的血管扩张药和正性肌力药物选用,IABP的积极使用,完备的体外循环和急救药的准备,防治患者围术期冠状动脉痉挛和心肌梗死。

Anesthesia for patients with serious main coronary disease undergoing coronary artery bypass grafting:

Objective:To analysis clinical characteristics and perioperative care for patients with serious main coronary disease undergoing coronary artery bypass grafting(CABG).Methods:From January 2001 to October 2010,486 patients with serious main coronary disease received CABG.The clinical data was collected and analyzed retrospectively.Results:442 patients received Off-pump CABG,28 patients received On-pump CABG,16 patients underwent acute conversion of off-pump CABG to on-pump CABG due to serious complications such as acute myocardial ischemia,tachycardia and hypotension.113 patients needed intra-aortic balloon pump(IABP) supporting including 8 preoperative implantation cases,78 intraoperative implantation cases and 27 postoperatve implantation cases.9 patients died within 72 hours after operation.Conclusion:The stability of heart rate and blood pressure,reasonable use of vasodilators and inotropic agents,adequate preparation of IABP and extracorporeal circulation are very vital factors for satisfied therapeutic management.