摘要
目的观察瑞芬太尼复合异丙酚对非体外循环冠状动脉搭桥手术患者术中血液动力学的影响以及术后恢复情况。方法非体外循环冠状动脉搭桥手术患者20例,麻醉用依托咪脂0.2-0.3 mg/kg、咪唑安定0.1-0.2 mg/kg、瑞芬太尼2μg/kg诱导,术中用瑞芬太尼0.1-0.3μg/（kg.min）和异丙酚2-4 mg/（kg.h）维持,在术前、开心包后、搬动心脏操作中、术毕和拔管后观察血液动力学指标及混合静脉血氧饱和度,同时采集桡动脉和肺动脉血,测定血气;观察术后拔除气管插管、ICU停留及术后住院时间、并发症及死亡等情况。结果患者术中血液动力学出现显著变化,心脏操作中平均动脉压（MAP）、心指数（CI）、左室每搏作功指数（LVSWI）、右室每搏作功指数（RVSWI）下降,心率（HR）、中心静脉压（CVP）、平均肺动脉压（MPAP）、肺毛细血管楔压（PCWP）升高（P〈0.01）;拔管时间（2.1±0.5）小时,ICU停留时间（1.8±0.7）天,术后住院时间（10.5±2.1）天;所有患者均无脑部并发症,1例出现房颤,无死亡病例。结论术中用瑞芬太尼复合异丙酚麻醉能使患者安全度过非体外循环搭桥术,但在心脏操作期间易出现血压、每搏量、心指数下降,伴心率、静脉压升高,处理及时无严重后果。
Objective To observe the clinical effect of Remifentanil on hemodynamic changes during off-pump coronary artery bypass grafting and Postoperative recovery of patients.Methods Twenty patients undergoing off-pump coronary artery bypass grafting were studied.Induction was used with etomidate-lipuro 0.2 0.3 mg / kg,midazolam 0.1 0.2 mg / kg and remifentanil 2 μg / kg,Intraoperative period with remifentanil 0.1～0.3 μg/（kg·min）,propofol 2～4 mg/（kg·h）to maintain.Observation of blood parameters and mixed venous oxygen saturation were obtained in the pre-operative period;after open the capsula cordis,during the heart manipulation,after the operation and post-extubation.At the same time,collection of radial artery and pulmonary artery blood samples to determine blood gas parameters.Parameters of the observation from patients after extubation,ICU stay and postoperative hospital stay,complications and death were recorded.Results Intraoperative hemodynamics changes significantly in the heart operation,while mean arterial pressure（MAP）,cardiac index（CI）,left ventricular stroke work index（LVSWI）,right ventricular stroke work index（RVSWI）,decreased heart rate（HR）,central venous pressure（CVP）,mean pulmonary artery pressure（MPAP）,pulmonary capillary wedge pressure（PCWP） increased（P 〈0.01）.Extubation time averaged（2.1 ± 0.5） h;ICU time（1.8 ± 0.7） d,postoperative length of stay（10.5 ± 2.1） d.All the patients had no brain complication.One patient showed atrial fibrillation with no deaths.Conclusions Intraoperative with remifentanil improved safety of patients through the off-pump bypass grafting.However,during manipulation of the heart operation,decrease of blood pressure;stroke volume and increase of cardiac index,heart rate,venous pressure,were observed with no serious consequences.
出处
《实用医院临床杂志》
2009年第3期67-69,共3页
Practical Journal of Clinical Medicine
关键词
冠状动脉搭桥术
血液动力学
心肺转流术
瑞芬太尼
Coronary artery bypass grafting
Hemodynamics
Cardiopulmonary bypass
Remifentanil
