经导管主动脉瓣植入手术中麻醉方法的评估

Evaluation of Anaesthetic Approaches in Transcatheter Aortic Valv Implantation Procedures.

作者信息

İzgi Murat, Halis Adem, Şener Yusuf Ziya, Şahiner Levent, Kaya Ergün Barış, Aytemir Kudret, Heves Karagöz Ayşe

机构信息

Department of Anaesthesiology and Reanimation, Faculty of Medicine Hacettepe University, Ankara, Turkey.

Department of Cardiology, Faculty of Medicine Hacettepe University, Ankara, Turkey.

出版信息

Turk J Anaesthesiol Reanim. 2023 Oct 24;51(5):427-433. doi: 10.4274/TJAR.231270.

DOI:10.4274/TJAR.231270

PMID:37876170

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10606737/

Abstract

OBJECTIVE

Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement and has become a popular treatment modality for inoperable or patients at high surgical risk with severe aortic stenosis. We aimed to evaluate our perioperative anaesthetic experiences with patients undergoing TAVI under sedation or general anaesthesia (GA).

METHODS

One hundred and fifty-nine patients who underwent TAVI procedures were enrolled. Effects on TAVI outcomes of sedation and GA were compared.

RESULTS

The duration of surgery and anaesthesia was significantly longer in patients who received GA. Insertion site complication and post-TAVI pacemaker implantation rates were similar between the groups, but the frequency of intraoperative complications (10% vs. 0.8%; =0.015), intraoperative hypotension (35.3% vs. 70%; < 0.001), and acute kidney injury (12.6% vs. 27.5%; =0.028) was significantly higher in the GA group. Stroke occurred in seven patients, and all were in the sedation group.

CONCLUSION

GA is related to increased procedure time and acute kidney injury; therefore, local anaesthesia and sedation may be the first option in patients undergoing TAVI.

摘要

目的

经导管主动脉瓣植入术（TAVI）已成为外科主动脉瓣置换术的替代方法，并已成为重度主动脉瓣狭窄、无法进行手术或手术风险高的患者的常用治疗方式。我们旨在评估在镇静或全身麻醉（GA）下接受TAVI的患者的围手术期麻醉经验。

方法

纳入159例行TAVI手术的患者。比较镇静和GA对TAVI结果的影响。

结果

接受GA的患者手术和麻醉时间明显更长。两组间穿刺部位并发症和TAVI术后起搏器植入率相似，但GA组术中并发症发生率（10% 对0.8%；P = 0.015）、术中低血压发生率（35.3% 对70%；P < 0.001）和急性肾损伤发生率（12.6% 对27.5%；P = 0.028）明显更高。7例患者发生卒中，均在镇静组。