非体外循环下冠脉搭桥术的围术期管理

目的：比较非体外循环搭桥术与体外循环搭桥术病人的术中及术后早期恢复情况。方法39例病人接受了非体外循环下冠脉搭桥术，同时期33例病人接受了体外循环冠脉搭桥术。两组均采用中等剂量阿片静脉复合全麻，结果：病人的麻醉时间、手术时间、术后机械通气时间和在监护室的停留时间，非体外循环组明显短于体外循环组（P＜0．01）。围术期平均输血量和血血病人数在1支桥病人中非体外循环组明显少于体外循环组（P＜0．05）。术后房颤发生率和围术期心肌梗死发生率两组间无明显差异，术后脑卒中，低心排及死亡的发生率各组均为0％。结论与外循环搭桥术相比，非体外循环搭桥术缩短了病人的麻醉、手术及在监护室停留时间，加快了病人的恢复、从耐而提高了手术的安全性，并降低了手术费用。

Perioperative management of patients undergoing off-pump coronary artery bypass grafting

Objective The aim of this study was to compare the intraoperative and early postoperative management of patients undergoing coronary artery bypass with or without cardiopulmonary bypass (CPB) and their results.Methods Off-pump coronary artery bypass grafting was performed on 39 patients (one graft on 25 patients and two grafts on 14 patients). During the same period, conventional coronary artery grafting under CPB were performed on 33 patients (one graft on 13 patients and two grafts on 20 patients). Intravenous anesthesia combined with medium dose opioid was performed in all patients.Results The durations of anesthesia and operation were significantly shorter in the off-pump group than those in the CPB group (P<0.01),so were the durations of postoperative mechanical ventilation, ICU stay and use of dopamine.The volume of blood transfusion and the number of patients receiving blood transfusion in patients who received one graft were significantly less in the off-pump group than those in the CPB group (P<0.05). There were no significant differences in the incidence of postoperative atrial fibrillation and perioperative myocardial infarction between the two groups. There were no postoperative stroke, low cardiac output syndromes, and deaths in either group.Conclusions Off-pump coronary artery grafting reduces the durations of anesthesia and operation and postoperative ICU stay. The patients recover faster thus increasing the safety of the surgery and reducing the surgical cost.