| Japanese |
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| Title | CABGの周術期管理と予後 |
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| Subtitle | 特集 シンポジウム(I) 『虚血性心疾患の治療と予後』 |
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| Authors | 杉本久*, 佐々木重幸*, 青井賢一郎*, 荻野真護*, 劔物修*, 松居喜郎**, 安田慶秀** |
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| Authors(kana) | |
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| Organization | *北海道大学医学部附属病院集中治療部, **北海道大学医学部循環器外科 |
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| Journal | 循環制御 |
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| Volume | 17 |
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| Number | 3 |
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| Page | 338-345 |
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| Year/Month | 1996/ |
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| Article | 報告 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 「緒言」CABGの予後を左右する最大の因子が血行再建の成否であることは言うまでもない. 術前に器質的な心筋の障害がない患者では, 血行再建後には良好な血行動態が得られるはずである. しかし, 周術期には心筋虚血を引き起こす因子がいくつも存在し, 外科的な血行再建が十分でも, それらの管理に失敗すれば周術期心筋梗塞を始め重篤な合併症を招来する. 著者らは, 大量フェンタニールを基礎とした十分な麻酔によって術中および術後早期に安定した血行動態を維持することを, 周術期管理の基本としている. 心筋虚血発生の危険が高い麻酔導入時, および体外循環離脱後の循環管理を回顧的に評価し, 退院までの短期予後から周術期管理の妥当性を検討した. 「対象」北海道大学医学部附属病院において自動麻酔記録システムが稼働を開始した1992年9月から1995年12月までの間に, 大量フェンタニール使用NLA麻酔下に手術され, ICUに入室した単独CABG77例を対象とした. 当院における同時期のPTCAは85例である. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | Perioperative management, Outcome, Coronary artery bypass graft surgery |
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| English |
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| Title | Perioperative Management and Outcome of Coronary Artery Bypass Graft Surgery (CAGB) |
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| Subtitle | |
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| Authors | Hisashi Sugimoto, Shigeyuki Sasaki, Kenichiro Aoi, Shingo Ogino, Osamu Kemmotsu, Yoshiro Matsui, Keishu Yasuda |
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| Authors(kana) | |
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| Organization | Division of Intensive Care Medicine, Hokkaido University Hospital, Department of Cardiovascular Surgery, Hokkaido University Hospital |
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| Journal | Circulation Control |
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| Volume | 17 |
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| Number | 3 |
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| Page | 338-345 |
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| Year/Month | 1996/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | We studied the perioperative management of 77 patients for jsolated coronary artery bypass graft surgery (CABG). Anesthesia management in these patients was similar even for the patients with old myocardial infarction (OMI), unstable angina pectoris (UAP), and left main trunncus region (LMT). Although more phenylephrine was used to the UAP and LMT patients, blood pressure was well maintained within 70% of preoperative value in these patients. Inotropic or mechanical support was more required in the UAP patients than those without UAP throughout the postbypass and early postoperative periods because of stunned myocardium. All the patients were transfered to the intensive care unit for postoperative management. We lost five patients in the hospital, and 3 of them had UAP. One patient underwent an emergency CABG for the progressive poor LV function in vain. One hundred and sixty of 175 ITA and SVG grafts were patent (91%) in the coronary arteriography before diseharge. Although one or two grafts were occluded in 12 patients, in only 2 patients significant PMI occurred. This fact may support the safety and efficacy of the use of inotropics for stunned myocardium in incomplete revascularization cases. We extubated endtraeheal tubes of patients without any complication in 13 hours after operation. We conclude that our perioperative management of CABG resulted in almost satisfactory outcome so far, but more sophisticated management and surgery for the UAP patients will be needed. (Circ Cont 17：338〜345, 1996) |
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| Practice | Basic medicine |
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| Keywords | Perioperative management, Outcome, Coronary artery bypass graft surgery |
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