严重三支病变行冠脉搭桥术患者的临床特点及麻醉管理

摘要

Objective To observe the clinical characteristics and evaluate the anesthetic method and results in severe three-vessel disease(3 VD) patients undergoing coronary artery bypass grafting (CABG). Methods In 68 3 VD patients undergoing CABG, the clinical characteristics and anesthetic treatment were recorded and analyzed, including baseline clinical data,cormorbid diseases, time data (operation time,extubation time,time in ICU, hospitalization time),complications rate, mortality rate. Results The severe 3 VD patients had high occurence in heart failure, diabetes, renal failure,and hypertension.High surgical risk was easily aroused due to complications such as arrhythmia(20.6%), infection(25.0%), hemodynamic instability(32.3%) during perioperative period and the overall mortality rate was 1.5%. Conclusion Cardiac and renal function usually degenerated in 3 VD patients undergoing CABG, we should especially pay attention to the mornitoring and protection in cardiac and renal function,and give effective treatment by means of vasoactive agents, antiarrythmic drug, and antibiotics.%目的：总结严重三支病变行冠脉搭桥术患者的临床特点和麻醉经验。方法对四川省人民医院收治的68例严重三支病变行冠脉搭桥术患者的基础临床状况、合并疾病、时间参数（手术时间、拔管时间、ICU停留时间、住院时间），并发症发生率、死亡率等临床数据进行收集整理，总结围术期用药特点和麻醉管理经验。结果严重三支病变患者心功能明显减退，合并糖尿病、肾功能不全、高血压等疾病较多，围术期容易发生心律失常(20.6%)、循环功能不稳(32.3%)、感染(25.0%)等并发症，总体死亡率1.5%。结论行冠脉搭桥术的三支病变患者，心肾功能减退更明显，围术期需加强心肾功能、心律失常、感染的监测，并及时应用相关血管活性药物、抗心律失常药物、抗感染药物等进行处理，避免严重并发症发生，可取得较理想的效果。