Baraka Anis S, Haroun-Bizri Sania, Shabb Bassem R, Khoury Samar S, Chehab Imad Rachid, Jalbout Maya I
Dept. of Anesthesiology, American University of Beirut, P.O. Box: 113-6044, Beirut.
Middle East J Anaesthesiol. 2002 Feb;16(4):387-96.
The objective of the report is to monitor, in patients undergoing minimally invasive direct coronary artery bypass surgery (MIDCAB), the haemodynamic parameters, ST segment changes and the incidence of arrhythmias during clamping of the coronary artery and following reperfusion.
Twelve patients scheduled for elective MIDCAB surgery during isoflurane anesthesia were enrolled in the study. Patients were monitored by a pulmonary artery thermodilution catheter, an arterial line and 5 leads ECG. The different haemodynamic parameters, the ST segment changes, as well as the occurrence of arrhythmias during coronary clamping and ten minutes following reperfusion were compared to the control values.
No significant changes in the cardiac index followed clamping of the coronary artery. However, the ST segment was significantly elevated. Following coronary reperfusion, the ST segment recovered to the baseline values, and the cardiac index significantly increased more than the baseline value (3.5 +/- 1.1 l/min/m2 vs 2.6 +/- 0.7 l/min/m2). However, reperfusion was associated with multiple ventricular extrasystoles in four patients. The elevation of the ST segments during coronary clamping was higher in the four patients who developed reperfusion arrhythmias (0.9 +/- 0.4 mm); one of the patients had preoperative frequent VPBs, two patients had history of unstable angina, while the fourth patient had 70% proximal stenosis of the LAD and recent myocardial infarction.
Coronary occlusion in patients undergoing MIDCAB can result in ST segment elevation, followed by reperfusion ventricular extrasystoles. The reperfusion arrhythmias were observed in patients showing a significant elevation of the ST segment during coronary occlusion; risk factors included a preoperative history of arrhythmia, unstable angina, recent MI, and/or 70% LAD stenosis. The rapid restoration of the control ST segment level and the significant increase of cardiac output following coronary reperfusion suggest that isoflurane anesthesia may have provided a degree of myocardial protection during coronary clamping and reperfusion.
本报告的目的是监测接受微创直接冠状动脉旁路移植术（MIDCAB）的患者在冠状动脉夹闭期间及再灌注后的血流动力学参数、ST段变化和心律失常发生率。
12例计划在异氟醚麻醉下进行择期MIDCAB手术的患者纳入本研究。通过肺动脉热稀释导管、动脉导管和5导联心电图对患者进行监测。将冠状动脉夹闭期间及再灌注后10分钟内的不同血流动力学参数、ST段变化以及心律失常的发生情况与对照值进行比较。
冠状动脉夹闭后心脏指数无显著变化。然而，ST段显著抬高。冠状动脉再灌注后，ST段恢复至基线值，心脏指数显著高于基线值（3.5±1.1升/分钟/平方米对2.6±0.7升/分钟/平方米）。然而，再灌注与4例患者的多个室性期前收缩有关。发生再灌注心律失常的4例患者在冠状动脉夹闭期间ST段抬高更高（0.9±0.4毫米）；其中1例患者术前有频发室性早搏，2例患者有不稳定型心绞痛病史，第4例患者左前降支近端狭窄70%且近期发生心肌梗死。
接受MIDCAB的患者冠状动脉闭塞可导致ST段抬高，随后出现再灌注室性期前收缩。在冠状动脉闭塞期间ST段显著抬高的患者中观察到再灌注心律失常；危险因素包括术前心律失常病史、不稳定型心绞痛、近期心肌梗死和/或左前降支狭窄70%。冠状动脉再灌注后对照ST段水平迅速恢复以及心输出量显著增加表明，异氟醚麻醉可能在冠状动脉夹闭和再灌注期间提供了一定程度的心肌保护。
