非体外循环冠状动脉架桥手术对心脏的影响_医学论文.docVIP

非体外循环冠状动脉架桥手术对心脏的影响_医学论文 非体外循环冠状动脉架桥手术对心脏的影响_医学论文 作者：陈敏　巩固　董辉　张英民　熊利泽 【关键词】 冠状动脉旁路移植术 关键词: 冠状动脉旁路移植术非体外循环麻醉 摘 要:目的 通过观察非体外循环下冠状动脉架桥手术时心脏的移位受压，分析与吻合冠状动脉相关的血液动力学改变. 方法 47例冠状动脉狭窄的患者，行非体外循环下冠状动脉架桥手术，采用CTS和octopuz两种固定器暴露吻合部位. 结果 少数患者在吻合右冠状动脉（RCA）和对角支（D）钝缘支（OM）时需辅以去甲肾上腺素0.02～0.20μg#12539kg-1 #12539min-1 以维持平均动脉压在9.3kPa以上.在所有吻合区每搏量SV和心脏指数CI都有少许下降，前降支LAD下降1mL和200mL#12539min-1 #12539m-2 ，RCA下降2mL和280mL#12539min-1 #12539m-2 ，D下降6mL和220mL#12539min-1 #12539m-2 ，OM下降1.6mL和220.0mL，与吻合前相比无统计学差异，在心脏复位15min后SV和CI恢复原来水平. 结论 非体外冠脉架桥手术时，心脏的受压和移位可引起血液动力学的改变，以上改变是短暂的且在生理范围之内. 　　Keywords:coronary artery bypass graftingoff-pumpanes-thesia 　　Abstract:AIM To observe heart displacement and compres-sion during off-pump CABG and to analyze the hemodynamic changes in relation to the grafted arteries.METHODS 47patients with coronary artery stenosis underwent off pump coronary artery bypass grafting，utilizing Octo-puz Tis-suetabiblization system（medtronic）and CTS Stabilization（cardiothoracic）to expose the anastomosic sites.RESULTS Some of the patients were given noradrenaline0.02～0.20μg#12539kg-1 #12539min-1 in order to maintain MAP above9.3kPa in suturing right coronary artery（RCA），diagonal branch artery（D），and obtuz marginal branch artery（OM）.During the surgery on the left anterior descending artery（LAD），stroke volume（SV）and cardiac index（CI）decresed1mL and200mL#12539min-1 #12539m-2 RCA，SV and CI decresed2mL and280mLD，SV and CI decresed6mL and220mL and OM，SV and CI decresed1.6mL and220.0mL#12539min-1 #12539m-2 （Pgt0.05）.All the cardiovascular indexes returned to base line values15min after releasing the heart.CONCLUSION This study provides evidence that the hemo-dynamic changes associated with heart displacement and com-pression during off pump CABG are of short duration and within physiological limit. 　　0 引言 　　每年全世界有超过80万名患者要行冠状动脉架桥术，在中国近10a内呈逐年上升趋势，增长了2～3倍.近些年来，很多外科医师开始尝试在非体外循环（Off pump）心脏跳动下完成冠状动脉旁路移植术［1］ .与常规冠状动脉架桥（coronary artery bypass graft，CABG）相比，微创避免了体外循环对正常生理状态的影响和心肌再