微创直接冠状动脉旁路移植术后是否进行通气：硬膜外麻醉的作用

To ventilate or not after minimally invasive direct coronary artery bypass surgery: the role of epidural anesthesia.

作者信息

de Vries Adrianus J, Mariani Massimo A, van der Maaten Joost M A A, Loef Bert G, Lip Harm

机构信息

Departments of Anesthesiology and Cardiothoracic Surgery, University Hospital Groningen, Groningen, The Netherlands.

出版信息

J Cardiothorac Vasc Anesth. 2002 Feb;16(1):21-6. doi: 10.1053/jcan.2002.29645.

DOI:10.1053/jcan.2002.29645

PMID:11854873

Abstract

OBJECTIVE

To evaluate the effect of immediate postoperative extubation and postoperative ventilation after minimally invasive direct coronary artery bypass (MIDCAB) surgery and to assess the role of epidural anesthesia.

DESIGN

Randomized prospective study.

SETTING

University hospital, single institution.

PARTICIPANTS

Patients (n = 90) scheduled for elective MIDCAB surgery.

INTERVENTIONS

Patients were divided into 3 groups: 30 patients had general anesthesia and were extubated immediately after surgery (extubated group), 30 patients had a thoracic epidural and general anesthesia and were extubated immediately after surgery (epidural group), and 30 patients had general anesthesia and were ventilated after surgery (intubated group).

MEASUREMENTS AND MAIN RESULTS

With a similar cardiac index and less vasoactive medication, mean arterial blood pressure (77 plus minus 8 mmHg [mean plus minus SD]) and heart rate (76 plus minus 10 beats/min) in the epidural group were lower on the first postoperative day than in the intubated group (83 plus minus 10 mmHg and 81 plus minus 13 beats/min) and the extubated group (86 plus minus 10 mmHg and 83 plus minus 13) (p = 0.01 and p = 0.09). Oxygenation on the first postoperative day was better in the epidural group than in the intubated group (14.8 plus minus 3.8 kPa v 12.6 plus minus 3.2 kPa; p = 0.05). The epidural group and the extubated group had a transient respiratory acidosis postoperatively. Pain score in the epidural group was lower on the first postoperative day than in the extubated group with general anesthesia (3.0 plus minus 1.6 visual analog scale v 4.6 plus minus 1.8 visual analog scale; p = 0.01). Hospital stay was shorter in the epidural group than in the ventilated group (5.9 plus minus 2.4 days v 8.1 plus minus 5.3 days; p = 0.05)

CONCLUSION

Immediate postoperative extubation in patients with thoracic epidural anesthesia and supplemental general anesthesia provides the most favorable clinical circumstances after MIDCAB surgery.

摘要

目的

评估微创直接冠状动脉旁路移植术（MIDCAB）术后即刻拔管和术后通气的效果，并评估硬膜外麻醉的作用。

设计

随机前瞻性研究。

地点

大学医院，单一机构。

参与者

计划接受择期MIDCAB手术的患者（n = 90）。

干预措施

患者分为3组：30例患者接受全身麻醉，术后即刻拔管（拔管组）；30例患者接受胸段硬膜外麻醉和全身麻醉，术后即刻拔管（硬膜外组）；30例患者接受全身麻醉，术后进行通气（插管组）。

测量指标及主要结果

硬膜外组术后第1天的平均动脉血压（77±8 mmHg[平均值±标准差]）和心率（76±10次/分钟）与插管组（83±10 mmHg和81±13次/分钟）及拔管组（86±10 mmHg和83±13次/分钟）相比，在心脏指数相似且血管活性药物使用较少的情况下较低（p = 0.01和p = 0.09）。术后第1天硬膜外组的氧合情况优于插管组（14.8±3.8 kPa对12.6±3.2 kPa；p = 0.05）。硬膜外组和拔管组术后有短暂的呼吸性酸中毒。硬膜外组术后第1天的疼痛评分低于全身麻醉的拔管组（视觉模拟评分3.0±1.6对4.6±1.8；p = 0.01）。硬膜外组的住院时间比通气组短（5.9±2.4天对8.1±5.3天；p = 0.05）。