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经导管主动脉瓣置换术(TAVI)中与麻醉相关的并发症和副作用:德国的一项回顾性研究。

Anaesthesia-related complications and side-effects in TAVI: a retrospective study in Germany.

机构信息

Department of Anaesthesiology, Universitatsklinikum Regensburg, Regensburg, Germany.

Department of Cardiothoracic Surgery, Universitatsklinikum Regensburg, Regensburg, Germany.

出版信息

BMJ Open. 2019 May 1;9(4):e025825. doi: 10.1136/bmjopen-2018-025825.

Abstract

OBJECTIVES

This study was performed to analyse anaesthesia-related complications and side effects in patients undergoing transcatheter aortic valve implantation (TAVI) under general anaesthesia.

DESIGN

Retrospective study.

SETTING

The study was performed as a single-centre study in a hospital of tertiary care in Germany.

PARTICIPANTS

All 853 patients, who underwent TAVI at the Universitätsklinikum Regensburg between January 2009 and July 2015, were included. 52.5% were female patients.

PRIMARY AND SECONDARY OUTCOME MEASURES

We gathered information, such as recent illness, vital parameters and medication administered during the intervention and postoperatively for 12 hours. We analysed all anaesthesia-related complications and anaesthesia-related side effects that occurred during the intervention and entire hospital stay.

RESULTS

We analysed all 853 TAVI procedures. The mean patient age was 79 ± 6 years. In 99.5% of cases, we used volatile-based anaesthesia. 2.8% (n=24; transfemoral (TF): n=19 [3.8%]; transapical (TA): n=5 [1.4%]) of all cases suffered from anaesthesia-related complications. 819 (TF: n=447; TA: n=372) anaesthesia-related side effects occurred in 586 (68.7%, TF: n=325 [64.2%], TA: n=261 [75.2%]) patients. Neither the complications nor the side effects had any serious consequences. Intraoperative hypothermia in 44% of cases (TF: n=202 [39.9%]; TA: n=173 [49.9%]) and postoperative nausea and vomiting in 27% (n=232; TF: n=131 [25.9%], TA: n=101 [29.1%]) of cases were the most common anaesthesia-related side effects.

CONCLUSION

In this study, serious anaesthesia-related complications were rarely seen, and non-critical anaesthesia-related side effects could have been avoided through consistent prophylaxis and management. Therefore, despite their high anaesthetic risk, general anaesthesia is justifiable in patients who underwent TAVI.

摘要

目的

本研究旨在分析在全身麻醉下接受经导管主动脉瓣植入术(TAVI)的患者的麻醉相关并发症和副作用。

设计

回顾性研究。

地点

该研究在德国一家三级护理医院进行,为单中心研究。

参与者

2009 年 1 月至 2015 年 7 月期间,在雷根斯堡大学医院接受 TAVI 的 853 名患者全部纳入研究。52.5%为女性患者。

主要和次要观察指标

我们收集了术中及术后 12 小时内的近期病史、生命体征和用药等信息。我们分析了术中及整个住院期间所有与麻醉相关的并发症和麻醉相关的副作用。

结果

我们分析了所有 853 例 TAVI 手术。患者平均年龄为 79±6 岁。99.5%的患者采用基于挥发性的麻醉。2.8%(n=24;经股动脉(TF):n=19[3.8%];经心尖(TA):n=5[1.4%])的患者出现与麻醉相关的并发症。819 例(TF:n=447;TA:n=372)与麻醉相关的副作用发生在 586 例(68.7%,TF:n=325[64.2%],TA:n=261[75.2%])患者中。并发症和副作用均无严重后果。术中低体温发生率为 44%(TF:n=202[39.9%];TA:n=173[49.9%]),术后恶心呕吐发生率为 27%(n=232;TF:n=131[25.9%],TA:n=101[29.1%]),为最常见的与麻醉相关的副作用。

结论

在本研究中,严重的麻醉相关并发症很少见,通过一致的预防和管理,可以避免非关键性的麻醉相关副作用。因此,尽管 TAVI 患者的麻醉风险较高,但全身麻醉是合理的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/72cc/6501997/0363dd8c9230/bmjopen-2018-025825f01.jpg

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