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1、齐鲁医学杂志2003年3月第18卷第1期 MedJQilu,March2003,Vol.18,No.1·1··论著·非体外循环冠状动脉旁路移置术的麻醉管理王世端 袁 莉 江 岩 韩洪鼎 王爱娟[摘要]①目的 评价非体外循环下冠状动脉旁路移置术(OPCABG)的麻醉管理技术及其效果。②方法19例行OPCABG的病人,麻醉诱导后以微量泵持续静脉输注异丙酚、利多卡因复合液,并间断注射芬太尼和维库溴铵(或哌库溴铵)维持麻醉。用硝酸甘油、苯肾上腺素、艾斯洛尔(或尼卡地平)及多巴胺等血管活性药物调控心率、血压,维持理想的循环状态
2、。手术全程监测动脉压、心电图、中心静脉压或(和)肺动脉楔压的变化,合理补充血容量。采用血液稀释自体输血与手术野血液回收相结合的血液保护技术。用肝素抗凝维持激活全血凝固时间大于300s。维持正常体温。③结果 2例因术中出现严重低血压并发室颤紧急改用体外循环下完成手术,另17例麻醉手术经过顺利。旁路移置1～2支5例,3支10例,4支(或4支以上)4例。11例未输异体血。术后机械通气时间4～11h,平均(8.5±3.3)h。无麻醉死亡。④结论 异丙酚、利多卡因复合液持续静脉输注,间断注射芬太尼和维库溴铵(或哌库溴铵)是OP
3、CABG的理想麻醉技术,术中良好的循环调控是保证手术顺利进行的关键,综合的血液保护技术可减少异体血的输入。[关键词]冠状动脉旁路移置术,非体外循环;麻醉;血流动力学[中图分类号]R654.2[文献标识码]A[文章编号]1008-0341(2003)01-0001-03ANESTHETICMANAGEMENTFOROFF2PUMPCORONARYARTERYBYPASSGRAFTINGWANGShiduan,YUANLi,JIANGYan,etalDepartmentofAnesthesiology,TheAffili
4、atedHospitalofQingdaoUniversityMedicalCollege,Qingdao266003[ABSTRACT]ObjectiveToevaluatetheeffectsofanestheticmanagementforoff2pumpcoronaryarterybypassgrafting(OP2CABG).MethodsNineteenpatientsundergoingOPCABGwereanesthetizedwithcomplexanesthesiabycontinuousadmi
5、nistrationofintravenouspropofol2lidocaineandintravenousbolusfentanylandvecuronium(orpipecuronium).Nitroglycerinewasusedbycontinuousintravenousdripduringtheoperation.Bloodpressureandheartratewereadjustedtothelevelof18.7-12.0/12.0-6.7kPaand50--175min,respectively
6、,byusingdopamine,phenylephrine,nitroprussideandesmolol(ornicardipine)tomaintainthehemodynamicsasstableaspossible.Heparin1.0-1.5mg/kgwasinjectedintravenouslytomaintaintheactivatedcoagulationtime(ACT)forlongerthan300s.ResultsThenumberofarteriesforbypassgraftingwa
7、s1-2in5cases,3in10cases,4in4cases.Twooutofthecaseswerechangedtoextracorporealcirculationduetoveryunstablehemodynamics.Elevencaseswerenotgivenallogenicbloodtransfusion.Thepostoperativeventilationdurationwas4-11h,averaging(8.5±3.3)h.Therewasnoanesthesia2relatedde
8、ath.ConclusionThecombinationofpropofolwithlidocaineivcontinuously,andfentanyl2vecuromiumivintermittentlyisanidealtechniqueforOPCABG.Thekeypointforsuccessofthesurgeryistocont
