摘要
目的:通过对比分析不停跳冠状动脉旁路移植术(OPCABG)联合同期肺癌根治与单纯OPCABG麻醉过程血流动力学监测结果等指标,总结OPCABG联合肺癌根治同期手术麻醉的管理经验。方法:对照分析20例OPCABG联合肺癌根治同期手术(Group A)与20例单纯OPCABG(Group B)麻醉管理,对监测心率(HR)、中心静脉压(CVP)、平均动脉压(MAP)、连续心排出量(CCO)、肺毛细血管崁压(PCWP)、氧摄取率(ERO_2)等数值以及麻醉时间、出血量及心律失常情况进行对比分析。结果:麻醉时间A组与B组差异有统计学意义,两组术中各出现1例心动过速及低血压,放置主动脉内球囊反搏(IABP)后缓解,频发室性早搏A组3例、B组2例,对症处理后缓解。心律失常总发生率两组差异无统计学意义,其余血流动力学监测指标及出血量两组比较,差异无统计学意义。结论:OPCABG联合肺癌根治同期手术患者的麻醉处理与常规OPCABG流程有所不同。麻醉中,维持血流动力学稳定、设法改善冠状动脉供血、做好单肺通气保证充分氧合是保证患者安全度过手术期的重要措施。
Objective:To compare the anesthetic management for off-pump coronary artery bypass grafting(OPCABG)combined with or without lung radical resection,to investigate the safety of anesthessia for this complex surgery.Methods:From Jannuary2013to December2015,the data of heart hate(HR),centra vein press(CVP),mean artery press(MAP),continuoius cardic output(CCO),pulmonary capillary wedge press(PCWP),oxygen extraction(ERO2)and mean of anesthetic time,operative bleeding and occurrence rates of cardic arrhythmia were recorded for20patients(Group A)underwent OPCABG and lung resection synchronously compared with20patients(Group B)carried out OPCABG only.Results:One patients in each of groups was treated by Intra Aortic Balloon Punp(IABP)for the myocardial ischemia,three patients in Group A and two patients in Group B were treated by pharmacotherapy for the frequent ventricular premature beat.With the statistic analysis of SPSS13.0,Mean of anesthetic time time were significantly different between Group A and Group B.The difference in mean of HR,CVP,MAP,CCO,PCWP,ERO2,operative bleeding and occurrence rates of cardic arrhythmia were not significantly between two groups.Conclusion:Different from the anesthesia for OPCABG only,it is important to perform complex surgery of OPCABG combined with lung radical resection safely with the experienced anesthetic management including maintenance of the stably haemodynamics,improvement myocardial ischemia and ensured oxygenation.
作者
迟慧
李秋霞
徐斐
CHI Hui;LI Qiuxia;XU Wen(Center for Anesthesiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing100029,China)
出处
《心肺血管病杂志》
2018年第11期1010-1013,共4页
Journal of Cardiovascular and Pulmonary Diseases
关键词
麻醉
不停跳冠状动脉旁路移植术
肺癌根治
Anesthesia
Off-pump coronary artery bypass grafting
Lung radical resection
