摘要
目的比较经导管主动脉瓣置换术(Transcatheter Aortic Valve Implantation,TAVR)患者清醒镇静与气管插管全麻下手术结局和安全性方面的差异。方法选择2020年3月至2022年5月于首都医科大学附属北京安贞医院麻醉中心接受经股动脉TAVR治疗的104例重度主动脉瓣狭窄(Aortic Stenosis,AS)患者进行回顾性分析。根据麻醉方式将患者分为清醒镇静组和插管麻醉组。在TAVR后1个月、6个月和12个月,使用健康状况调查问卷(the MOS item short fromhealth survey,SF-36)和欧洲五维度健康量表(European five-dimension Health Scale,EuroQol-5D)以及巴塞尔指数评定量表评估患者生活质量和自理能力。围手术期结局包括术后谵妄(Postoperative Delirium,POD)发生率和重症监护病房(ICU)住院天数。安全性结局定义为死亡、卒中、短暂性脑缺血发作、急性心肌梗死、需要透析、重大血管并发症、重大或危及生命的出血和需要永久性起搏器植入的复合事件。结果与插管麻醉组相比,清醒镇静组患者围手术期POD发生率显著降低,ICU住院时间显著缩短,差异有统计学意义(P<0.05)。清醒镇静组和插管麻醉组在术后SF-36评分、EuroQol-5D评分和Barthel量表评分等方面均无显著差异(P>0.05)。两组术后安全性复合结局比较,差异无统计学意义(P>0.05)。结论与气管插管全身麻醉相比,清醒镇静TAVR可减少POD和ICU住院时间,不影响安全性和患者生活质量。清醒镇静下TAVR对于AS患者是一种安全、有效的手术方式,是全身麻醉的可接受替代方案。
Objective To compare the outcomes and safety of patients undergoing transcatheter aortic valve replacement(TAVR)with conscious sedation and intubation general anesthesia.Methods A retrospective analysis was conducted on 104 patients with severe aortic stenosis(AS)who received TAVR treatment by the femoral artery at the AnesthesiaCenter of Beijing Anzhen Hospital Affiliated to Capital Medical University from March 2020 to May 2022.A retrospective analysis of 104 patients with severe aortic stenosis(AS)who were treated in the hospital with transfemoral TAVR between March 2020 and May 2022 was conducted.According to the method of anesthesia,all patients were divided into conscious sedation group and intubation anesthesia group.At 1,6,and 12 months after TAVR,patients'quality of life and self-care ability were assessed using the MOS item short fromhealth survey(SF-36)and the European five-dimension Health Scale(EuroQol-5D),as well as the Barthel Index Rating Scale.Perioperative outcomes included postoperative delirium(POD)incidence and length of stay in intensive care unit(ICU).Safety outcomes were defined as complex events involving death,stroke,transient ischemic attack,acute myocardial infarction,need for dialysis,major vascular complications,major or life-threatening bleeding,and the need for permanent pacemaker implantation.Results Compared with the intubation anesthesia group,the incidence of POD in the perioperative period of patients in the conscious sedation group was significantly reduced,and the length of ICU stay was significantly shortened,with statistical significance(P<0.05).There were no significant differences in SF-36 score,EuroQol-5D score and Barthel scale score between conscious sedation group and intubation anesthesia group(P>0.05).There was no significant difference in postoperative safety composite outcome between the two groups(P>0.05).Conclusion Compared to tracheal intubation general anesthesia,conscious sedation TAVR can reduce POD and ICU stay time without compromising safety and patient quality of life.TAVR under conscious sedation is a safe and effective surgical procedure for AS patients and an acceptable alternative to general anesthesia.
作者
王轶芃
周程辉
刘达琪
WangYipeng;Zhou Chenghui;Liu Daqi(Anesthesia Center of Beijing Anzhen Hospital Affiliated to Capital Medical University,Beijing 100029;不详)
出处
《中国循证心血管医学杂志》
2024年第5期538-542,共5页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
国家自然科学基金项目(81970290)。
关键词
经导管主动脉瓣置换术
全身麻醉
手术结局
安全性
Transcatheter aortic valve replacement
General anesthesia
Surgical outcome
Security
