摘要
连续观察 2 2 5例体外循环下行冠状动脉旁路移植术 (CABG)患者 ,总结术后早期处理的要点。精细调整心脏前后负荷和心脏功能 ,使机体保持“干燥状态”,白蛋白是补充血容量的最佳选择 ,术前术后心功能差者术后用多巴胺支持 ,有IABP适应证时及早使用。联合应用β受体阻断药和地高辛可使房颤转复率达 95 %。强调使用呼气末正压 (PEEP) ,及早拔除气管插管有助于肺功能恢复 ,PaO2 >6 5mmHg拔管是安全的。渗血多时输血液制品 ,不需用止血药。 2例因围术期心梗、1例因鱼精蛋白过敏性休克死亡 ,余者痊愈出院。并发症发生率 2 2 % :1例纵隔炎、1例胸骨哆开、1例肋骨无菌性炎症 ,均清创痊愈 ,2例脑梗死 ,治疗后好转。平均住ICU(3 0± 2 6 )天 ,术后住院 (8 2± 1 5 )天。CABG术后早期全面、精细的处理对顺利恢复至关重要 。
To introduce our experiences of specific early management after CABG, 225 patients who accepted CABG employing extra corporeal bypass(CPB) were studied. Meticulous adjustment of preload and afterload and pump function was critical to optimize cardiac function. Human albumin was considered to be the best agent for keeping a 'dry body'. Dopamine was pump infused for preoperative and postoperative left ventricular dysfunction, and intraortic balloon pump counterpulsation (IABP) was used without hesitation when indicated. Combined use of β blocker and digoxin was effective to reverse atrial fibrillation to sinus rhythm with effectiveness of 95%. PEEP was routinely used when the patient was ventilated. Early extubation was safe if PO 2 was >65mmHg. Sufficient blood products might be indicated when there was excessive oozing. Anticoagulant was not necessary. Two patients died of perioperative myocardial infarction and one of allergic shock to protamine. An incidence of postoperative complications as low as 2 2% (5/225) was obtained. Five patients were found to have various postoperative complications, which were completely cured. All the rest patients were uneventful, and they were discharged after (3 0±2 6) days of stay in the ICU and (8 2±1 5) days after the operation. Therefore, it is our belief that comprehensive and careful postoperative management is essential to achieve excellent results.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2002年第3期261-262,共2页
Medical Journal of Chinese People's Liberation Army
