|
| 不停跳冠脉旁路移植术联合肺癌根治术的麻醉管理 |
| Anesthesia for the patients undergoing the surgery of off-pump coronary bypass grafting and radical resection of lung cancer |
| |
| DOI：10.12089/jca.2019.04.014 |
| 中文关键词: 麻醉 不停跳冠脉旁路移植 肺癌根治 |
| 英文关键词: Anesthesia Off-pump coronary artery bypass grafting Lung resection |
| 基金项目: |
|
| 摘要点击次数: 3034 |
| 全文下载次数: 688 |
| 中文摘要: |
目的 回顾并总结不停跳冠状动脉旁路移植（OPCABG）联合肺癌根治同期手术的麻醉管理方法。
方法 收集2003年5月至2018年1月静脉复合麻醉同期手术46例患者的麻醉管理资料，年龄53～77岁，ASAⅡ或Ⅲ级。记录术中HR、CVP、MAP、CI、PCWP、混合静脉血氧饱和度（SvO2）和动脉血乳酸浓度（Lac）,计算肺血管阻力（PVR）、全身血管阻力（SVR）、氧供（DO2）、氧耗（VO2）和氧摄取率（ERO2）并对同期手术麻醉风险进行回顾分析。
结果 所有患者顺利完成同期手术，无死亡病例。2例术中发生心肌缺血、低血压，放置主动脉内球囊反搏（IABP），4例出现低心排给与去甲肾上腺素治疗。麻醉诱导后各时点HR、MAP较术前明显下降（P<0.01），术中各时点SVR、PVR、 VO2、Lac较诱导后明显下降（P<0.05或P<0.01），CI、DO2与ERO2较诱导后明显增加（P<0.05或P<0.01）。
结论 麻醉重视术前准备和术中监测，维持术中血流动力学稳定及心肌氧供需平衡，做好心肺功能维护能够保证OPCABG联合同期肺癌根治手术顺利实施。 |
| 英文摘要: |
Objective To review and summarize the experience of anesthetic management of combined operation for patients who need off-pump coronary artery bypass grafting (OPCABG) and radical resection of lung cancer synchronously.
Methods From May 2003 to Jannuary 2018, 46 patients underwent OPCABG and lung resection synchronously, aged 53-77 years, ASA physical status Ⅱ or Ⅲ, were includel in this study. The data of heart rate (HR), mean artery press (MAP), cardic-output index (CI), pulmonary capillary wedge press (PCWP), mixed venous oxygen saturation (SvO2) and lactic acid concentration (Lac) were recorded for 40 patients in different time-point during the procedure of combine operations. Pulmonary vascular resistance (PVR), systemic vascular resistance (SVR), oxygen delivery (DO2), oxygen consumpation (VO2) and oxygen extraction (ERO2) were calculated and a retrospective study was performed.
Results There was no hospital death in this series. Two patients were treated by intra aortic balloon punp (IABP) for the myocardial ischemia and four patients were treated with Norepinephrine for low cardic-output. HR and MAP decreased significantly between anesthesia F/R (P < 0.01). SVR,PVR, VO2 and Lac decreased significantly between thoractomy F/R (P < 0.05 or P < 0.01). CI, DO2 and ERO2 increased between operation F/R (P < 0.05 or P < 0.01).ASA,EF had significant effect on the risk of anesthesia for the combined operations.
Conclusion With experienced anesthetic management including maintenance the stably haemodynamics, cardic function and ensured oxygenation， it is feasible and safe to perform surgery treatment of OPCABG and lung resection synchronously. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
