体外循环及非体外循环冠状动脉旁路移植术麻醉方法及术后恢复对.docVIP

体外循环及非体外循环冠状动脉旁路移植术麻醉方法及术后恢复对 　 作者：周琪，王刚，高长青，陈婷婷，李佳春 【摘要】 目的比较体外循环和非体外循环冠状动脉旁路移植术（OPCAB）的麻醉方法及术后恢复情况。 方法131例择期行冠状动脉旁路移植术（CABG）患者随机分为体外循环组（on-pump组，n=45）和非体外循环组（off-pump组，n=86），比较两组的麻醉药用量，术中失血及补液，麻醉恢复，术后并发症以及心肌酶变化等情况。 结果两组患者术前资料相似。off-pump组麻醉时间较on-pump组短［（244±47）min Vs （312±59）min］（Plt;0.05）。on-pump组术中出血量、自体血回输量、红细胞、血浆及血小板用量均多于off-pump组（Plt;0.05）。两组患者血管吻合支数［off-pump组（2.7±0.6） Vs on-pump组（2.9±0.7）］无显著差异（Pgt;0.05）。两组患者围术期均无死亡。与on-pump组相比，off-pump组术后苏醒时间、呼吸机辅助时间、气管导管拔出时间及ICU停留时间明显缩短（Plt;0.05）。off-pump组术后肾、肺及中枢神经系统并发症发生率明显低于on-pump组（Plt;0.05）。两组CK-MB术后均升高，on-pump组明显高于off-pump组（Plt;0.05）。 结论两组患者麻醉效果满意，OPCAB手术对麻醉要求更高。与传统CABG手术相比，OPCAB术后并发症发生率低，恢复更快。 【关键词】 体外循环；非体外循环；冠状动脉旁路移植术；麻醉；并发症 　　Comparison of Anesthetic Management and Early Outcome withOn-Pump and Off-Pump Coronary Artery Bypass Grafting 　　Abstract: OBJECTIVETo compare the anesthetic management and early outcome of on-pump and off-pump CABG in a prospective randomized controlled trial. METHODS131 consecutive unselected patients referred for elective primary CABG were randomly assigned to accept either on-pump (n=45) or off-pump (n=86) CABG. The anesthetic management and clinical outcomes were compared. RESULTSThe operation time in off-pump group was significantly shorter than that in on-pump group ［（244±47）min VS.（312±59）min］(Plt;0.05). The bleeding and frequency of need for blood or blood products transfusion was higher in on-pump group compared with off-pump group (Plt;0.05). The number of grafts performed per patient［（2.7±0.6）for off-pump CABG and（2.9±0.7）for on-pump CABG ］were similar. There were no hospital deaths in either group. The incidence of perioperative complications in off-pump group was significantly lesser than that in on-pump group (Plt;0.05). Postoperative serum CK-MB levels increased above normal value in the two groups, but it was more pronounced in on-pump group (Plt;0.05). CONCLUSIONOPCAB with multiple arterial grafts is as safe as traditional CABG. The incidence of perioperative complications