200例非体外循环冠状动脉旁路移植术的麻醉处理

目的：探讨非体外循环冠状动脉旁路移植术（off-pump coronary artery bypass grafting,OPCABG）患者的围术期管理。方法：回顾分析2005年7月至2008年6月的200例择期非体外循环下冠状动脉旁路移植术患者200例,诱导用咪唑安定0.05～0.1mg/kg,依托咪酯0.3mg/kg,芬太尼5～15μg/kg,罗库溴铵0.5～1.0mg/kg,麻醉维持采用持续泵注异丙酚1～4mg/kg·h,,间断辅以0.5%～2.0%异氟烷吸入,术中随手术操作时出现的血流动力学变化,用血管活性药物调整。结果：麻醉效果满意,术中血压心率基本满意。本组患者苏醒时间,拔管时间和ICU停留时间为（178±42）min、（10.5±4.0）h、（18±6.3）h。术毕180例患者在12h内拔管。180例预后良好,无麻醉并发症。结论：非体外循环下冠状动脉旁路移植术麻醉管理的关键是合理的应用麻醉药和血管活性药来维持血流动力学平稳。

Anesthesia for 200 Patients Undergoing Off-Pump Coronary Artery Bypass Surgery

Objective：To summarize the technique and evaluate the effect of anesthesia for off-pump coronary artery bypass surgery （OPCAB）.Methods：From July of 2005 through June of 2008,two hundred consecutive patients undergoing OPCAB were retrospectively studied.Anesthesia was induced with midazolam 0.05-0.1mg/kg,or etomidate 0.3mg/kg and fentanyl 5-15μg/kg.Anesthesia was maintained with isoflurane 0.5%-2.0% and oxygen,combined with propofol 1-4mg/（kg·h）.Intraoperative hypotension resulting from either surgical procedure or anesthetics should be dealt with inotropes immediately.Results：Intraoperative hemodynamics deviation was tolerated with the support of inotropics.The mean of patients of consciousness recovery time,tracheal extubation time and stay in ICU time were 178±42 min,10.5±4.0 hours and 18±6.3 hours.The patients were discharged in 8.0±1.2 days.Racheal intubation were remained 12 hours in 180 patients after operation,180 patients had good recovery without any anesthesia complications.Conclusion：Rational use of anesthetics and inotropics to stabilize hemodynamics during operation plays a key role in successful OPCAB.