Gatti Giuseppe, Piccione Riccardo, Pugliese Peppino
Department of Cardiac Surgery, Villa Torri Hospital, Bologna, Italy.
Ital Heart J. 2003 Aug;4(8):565-7.
Minimally invasive coronary artery surgery is nowadays considered a safe surgical strategy. We report a case of a 70-year-old man with a high operative risk who underwent off-pump coronary artery bypass grafting using only high thoracic epidural anesthesia without intubation. The patient well tolerated each phase of the operation. The effect of the movement of the chest wall and the heart during spontaneous respiration did not influence the conduction of the operation. The postoperative course of the patient was uneventful. At follow-up the patient was asymptomatic. Repeat coronary arteriography and echocardiography respectively confirmed the patency of the anastomoses and the improvement of the left ventricular performance. In carefully selected cases thoracic epidural anesthesia for off-pump coronary artery bypass grafting in spontaneously breathing conscious patients is feasible and may offer many benefits.
如今，微创冠状动脉手术被认为是一种安全的手术策略。我们报告一例70岁男性患者，其手术风险高，接受了仅使用高位胸段硬膜外麻醉且未插管的非体外循环冠状动脉旁路移植术。患者对手术的各个阶段耐受性良好。自主呼吸期间胸壁和心脏运动的影响并未干扰手术操作。患者术后恢复顺利。随访时患者无症状。重复冠状动脉造影和超声心动图分别证实了吻合口通畅以及左心室功能改善。在精心挑选的病例中，对自主呼吸清醒患者进行非体外循环冠状动脉旁路移植术采用胸段硬膜外麻醉是可行的，且可能带来诸多益处。
