经导管主动脉瓣置换术中局部麻醉和全身麻醉患者临床结局的比较  

Comparison of the outcomes of local anesthesia and general anesthesia in transcatheter aortic valve replacement

作　　者：程洋 李茜[1] 李怡坚 欧袁伟翔 王玺 李侨[1] 彭勇[1] 冯沅[1] 陈茂[1] CHENG Yang;LI Xi;LI Yijian;OU Yuanweixiang;WANG Xi;LI Qiao;PENG Yong;FENG Yuan;CHEN Mao(Department of Cardiology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西医院心脏内科,成都610041

出　　处：《华西医学》2020年第9期1055-1059,共5页West China Medical Journal

基　　金：四川省科学技术厅重点研发项目(2019YFS0349)。

摘　　要：目的比较不同麻醉方式的经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)患者的临床结局。方法研究对象为在2012年4月-2019年1月于四川大学华西医院成功行TAVR的399例重度症状性主动脉瓣狭窄患者。收集所有入选患者的术前基线资料、手术情况、术后临床结果和超声随访数据。对所有患者进行临床随访,随访终点日期为2020年6月20日。依据术中麻醉方式,将入选患者分为局部麻醉(局麻)组和全身麻醉(全麻)组,对比不同麻醉方式患者的术后并发症发生率、血流动力学参数、术后30 d和1年的死亡率是否存在差异。结果共纳入399例患者,其中206例(51.6%)接受局麻,193例(48.4%)接受全麻。两组患者基线资料相似,术后随访患者症状整体均有不同程度的缓解,生活质量改善明显,但局麻组出现轻度、严重出血事件(12.4%vs.1.5%,P<0.001;10.4%vs.0.5%,P<0.001)与主要血管并发症(0.5%vs.3.6%,P=0.032)的概率较低,术后30 d的全因死亡率也较低(1.9%vs.6.7%,P=0.018)。结论与全麻相比,局麻患者出血事件、主要血管并发症发生率较低且术后30 d死亡率也较低。Objective To compare the outcomes of local anesthesia and general anesthesia in transcatheter aortic valve replacement(TAVR).Methods A total of 399 severe aortic stenosis patients were included,who underwent TAVR successfully in West China Hospital of Sichuan University between April 2012 and January 2019.The baseline characteristics,procedural details,postprocedural outcomes,and ultrasound data of those patients were collected.All patients were followed up and the end date of follow-up was June 20 th 2020.According to anesthetic mode,the patients were divided into local anesthesia group and general anesthesia group.The differences between the two groups in incidence of postprocedural complications,hemodynamics,postprocedural 30-day mortality,and postprocedural 1-year mortality were retrospectively analyzed.Results Of the 399 patients,206(51.6%)received local anesthesia and 193(48.4%)received general anesthesia.There was no statistical difference between the two groups in baseline characteristics.The symptoms of both groups were relieved.But the incidences of mild bleeding events(12.4%vs.1.5%,P<0.001),severe bleeding events(10.4%vs.0.5%,P<0.001),major vascular complications(0.5%vs.3.6%,P=0.032),and postprocedural 30-day all causes mortality(1.9%vs.6.7%,P=0.018)were significantly lower in the local anesthesia group than those in the general anesthesia group.Conclusion In TAVR,compared with general anesthesia,local anesthesia is safer to use with lower incidence of postprocedural complications and postprocedural 30-day all causes mortality.

关 键 词：经导管主动脉瓣置换术 局部麻醉 全身麻醉 死亡率 重度主动脉瓣狭窄 

分 类 号：R614[医药卫生—麻醉学]