急性失代偿性心力衰竭患者在体外膜肺氧合支持下行经导管主动脉瓣置换术的麻醉管理：一例报告
Anesthetic Management of Transcatheter Aortic Valve Replacement under Extracorporeal Membrane Oxygenation in a Patient with Acute Decompensated Heart Failure: A Case Report.
作者信息
Okada Takuya, Yoshida Takuya, Makino Shohei, Obata Norihiko, Mizobuchi Satoshi
机构信息
Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan.
出版信息
Kobe J Med Sci. 2019 Nov 14;65(3):E90-E94.
Abstract
We managed general anesthesia for transcatheter aortic valve replacement (TAVR) under elective extracorporeal membrane oxygenation (ECMO) in a patient with aortic valve stenosis (AS) complicated with acute decompensated heart failure. The patient was an 87-year-old woman with acute heart failure due to severe AS who had been hospitalized. However, her low cardiac output did not improve, and weaned her off catecholamines was difficult, so semi-urgent TAVR was performed. Due to her acute decompensated heart failure complicated by low-left ventricular function, we decided electively to use ECMO for transfemoral TAVR to prevent hemodynamic collapse during induction of anesthesia and surgery, enabling the safe perioperative management of this patient under general anesthesia.
摘要
我们为一名患有主动脉瓣狭窄（AS）并伴有急性失代偿性心力衰竭的患者，在择期体外膜肺氧合（ECMO）支持下进行经导管主动脉瓣置换术（TAVR）实施全身麻醉。该患者为一名87岁女性，因严重AS导致急性心力衰竭而住院。然而，她的心输出量较低且未改善，停用儿茶酚胺困难，因此进行了半紧急TAVR。由于她急性失代偿性心力衰竭合并左心室功能低下，我们决定选择性地在经股动脉TAVR中使用ECMO，以防止麻醉诱导和手术期间的血流动力学崩溃，从而在全身麻醉下实现该患者的围手术期安全管理。
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