丙泊酚静吸复合麻醉用于不停跳冠状动脉搭桥术的麻醉效果

目的探讨丙泊酚联合瑞芬太尼在非体外循环下冠状动脉搭桥手术(OPCABG)的麻醉效果及其对血流动力学的影响。方法拟行OPCABG手术患者38例,麻醉诱导成功后,采用丙泊酚5～8mg/(kg h)联合瑞芬太尼10～15μg/(kg h)作麻醉维持,同时间断吸入异氟醚,注射维库溴铵调控麻醉深度。经桡动脉、右颈内静脉穿刺测压,监测围术期各时段HR、MAP、CVP、MPAP、PCWP的变化。结果麻醉诱导及麻醉维持血流动力学稳定,在搭桥再血管化时,术者垂直搬动心脏,暴露心脏后侧壁、下壁,置心外固定器时血流动力学紊乱比较明显。结论丙泊酚联合瑞芬太尼平衡麻醉应用于OPCABG手术,血流动力学平稳,麻醉效果确切。

Anesthesia Effects of Propofol and the Combined Intravenous Inhalation Anesthesia Applied in Off-pump Coronary Artery Bypass Grafting Surgery

Objective To explore the anesthesia effect of propofol in combination with lemifentanil in off-pump coronary artery bypass grafting surgery （OPCABG） and the impact on hemodynamics. Methods 38 cases of patients will receive OPCABG surgery. After successful induction of anesthesia, 5-8mg/（kg.h） of propofol in combination with remifentanil 10～15μg/（kg.h） was used for anesthesia maintenance. While inhalation of isoflurane, intermittent injection of vecuronium was used to regulate the deep anesthesia. Manometry was conducted through puncture in radial artery and right internal jugular vein, the change of HR, MAP, CVP, MPAP, PCWP during perioperative period was monitored. Results The hemodynamics of anesthesia induction and anesthesia maintenance was relatively stable, while bypass revascularization, hemodynamic disorders were quite apparent when operator vertically moved the heart and exposed after inferior lateral wall, lower wall of heart for external fixation. Conclusion The application of propofol in combination with remifentanil in the medium dose to balance anesthesia in OPCABG surgery confers stable hemodynarnics with the good effect of anesthesia.