Butler J, Chong G L, Pillai R, Westaby S, Rocker G M
Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, UK.
J Cardiovasc Surg (Torino). 1992 May-Jun;33(3):276-80.
The effect of extubation within the first postoperative hour was evaluated in 13 patients (mean +/- SD age 59 +/- 6 years) undergoing elective coronary artery bypass surgery without active systemic hypothermia. The mean cardiopulmonary bypass time was 50 +/- 14 minutes. Postoperative improvements in cardiac index and oxygen uptake (from 2.0 +/- 0.4 l/min/m2 and 144 +/- 26 ml/min postinduction to 2.88 +/- 0.76 l/min/m2 and 229 +/- 104 ml/min, p less than 0.01) were maintained following extubation. Lower postoperative systemic and pulmonary vascular resistances (p less than 0.01) did not change to a significant extent following extubation. Despite a two-fold rise in the intrapulmonary shunt (Qs/Qt) following surgery (18.5 +/- 9.7% vs 9.6 +/- 3.2% before surgery) the immediate post-extubation value was similar (18.8 +/- 8.2%) and all patients were discharged from the cardiac recovery area within 16 hours without complication. Extubation within the first postoperative hour is a safe procedure following elective coronary artery surgery with short bypass times where sustained hypothermia less than 32 degrees C is avoided.
对13例择期冠状动脉搭桥手术且未进行主动全身低温治疗的患者（平均年龄±标准差为59±6岁）评估术后1小时内拔管的效果。平均体外循环时间为50±14分钟。拔管后心脏指数和氧摄取的术后改善情况（从诱导后2.0±0.4升/分钟/平方米和144±26毫升/分钟提高到2.88±0.76升/分钟/平方米和229±104毫升/分钟，p<0.01）得以维持。术后较低的全身和肺血管阻力（p<0.01）在拔管后未发生显著变化。尽管术后肺内分流（Qs/Qt）增加了两倍（手术前为9.6±3.2%，手术后为18.5±9.7%），但拔管后即刻的值相似（18.8±8.2%），所有患者均在16小时内无并发症地从心脏康复区出院。对于体外循环时间短且避免持续体温低于32摄氏度的择期冠状动脉手术后，术后1小时内拔管是一种安全的操作。
