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Anesthetic Progress in Patients Undergoing Off－pump Coronary Artery Bypass Grafting

赵丽云　综述　卿恩明　审校

首都医科大学附属北京安贞医院，北京100029

Li－yun Zhao；En－ming Qing

Department of Anesthesiology，Beijing Anzhen Hospital，Capital University of Medical Science，Beijing 100029

ABSTRACT

　　The patients undergoing off－pump coronary artery bypass grafting（OPCABG）are increasing with the development of surgical techniques and devices. The keys of success for OPCABG are perfect pre－operative preparations and anaesthetic induction，stable hemodynamics during operation，gentle cardiac manipulation，myocardial ischemia prevention and the use of intra aorta balloon pump （IABP） and transesophagus echocardiography （TEE）. Anesthesiologists involved in cardiac surgery must have knowledge of this specific procedure and its requirements，and to prevent and treat the hemodynamic instability and severe heart complications. This article will review the progresses of all problems above.

　　Key words：Coronary artery；Revascularization；Off－pump；Anesthesia；Progress

　　Corresponding author：Li－yun Zhao

　　早年的CABG多是在体外循环（CPB）下进行，虽然可缓解患者的症状，但住院时间较长，费用高，并发症多。多年的实践与探索，逐渐趋向于脱泵下冠状动脉搭桥术（OPCABG），最初的OPCABG仅用于心脏前面的左前降支或右冠状动脉干的病变，随着经验的积累、麻醉技术的提高，现在可以完成回旋支、对角支等多支病变的OPCABG。不仅创伤小、恢复快，呼吸机辅助时间、住院时间明显缩短，医疗费用也相应降低，而且避免了由体外循环导致的一系列并发症，如凝血功能异常及过度的炎症反应对重要脏器的损伤等^[1～3]。