咽喉部表面麻醉在老年心房颤动患者左心耳封堵术中的应用  

Application of laryngopharyngeal surface anesthesia in left atrial appendage closure in elderly patients with atrial fibrillation

作　　者：王旭[1] 陈超[1] Wang Xu;Chen Chao(Department of Anesthesia,the Ninth People's Hospital Affiliated toMedical College of Shanghai Jiaotong University,Shanghai,200011,P.R.China)

机构地区：[1]上海交通大学医学院附属第九人民医院麻醉科,上海200011

出　　处：《老年医学与保健》2021年第2期381-384,共4页Geriatrics & Health Care

摘　　要：目的观察咽喉部表面麻醉对老年患者全身麻醉下行左心耳封堵术(LAAC)的效果。方法 2016年9月一2019年6月上海交通大学医学院附属第九人民医院拟全身麻醉下行LAAC的老年阵发性/持续性非瓣膜性房颤(NVAF)患者56例,随机分为对照组(全身麻醉)和观察组(全身麻醉复合咽喉部利多卡因喷雾表面麻醉),每组28例。观察麻醉诱导前(T0)、气管插管即刻(T1)、置入经食管超声心动图(TEE)即刻(T2)、封堵器放置即刻(T3)和拔除气管导管即刻(T4) 5个时间点的收缩压(SBP)、舒张压(DBP)、心率(HR);记录心血管不良事件的发生情况。结果与T0时比较,对照组 T1、T2 时 HR 均增快(F=7.108,P<0.05);T2 时 SBP 降低(F=19.600,P<0.05);T1时 DBP 升高,T2时DBP降低(F=10.450,P<0.05)。与T0时比较,观察组T2时SBP降低(F=5.857,P<0.05)。T1时观察组HR较对照组减慢(P<0.01),SBP和DBP均较对照组降低(均P<0.01);T2时HR较对照组减慢(P<0.05)、SBP和DBP均较对照组升高(P<0.05)。与对照组比较,观察组高血压、低血压、快房颤伴低血压发生比例降低,差异均有统计学意义(均P<0.05)。结论全身麻醉下,老年房颤患者行LAAC是安全可行的,咽喉部表面麻醉可能有利于维持循环稳定,减少快房颤等心血管不良事件的发生。Objective To observe the effect of laryngeal surface anesthesia on left atrial appendage closure(LAAC)in elderly patients under general anesthesia.Methods From September 2016 to June 2019,56 elderly patients with paroxysmal/persistent nonvalvular atrial fibrillation(NVAF) undergoing LAAC under general anesthesia in the Ninth People’s Hospital Affiliated to Medical College of Shanghai Jiaotong University were enrolled and randomized divided into the control group(general anesthesia) and observation group(general anesthesia combined with lidocaine spray surface anesthesia),28 cases in each group.Systolic blood pressure(SBP),diastolic blood pressure(DBP) and heart rate(HR) were measured before anesthesia induction(T0),immediately after tracheal intubation(T1),immediately after transesophageal echocardiography(TEE) insertion(T2),immediately after occluder placement(T3) and immediately after extubation(T4),and the incidence of cardiovascular adverse events was recorded.Results Compared with T0,HR increased at T1 and T2 in the control group(F=7.108,P<0.05),SBP decreased at T2(F=19.600,P<0.05),DBP increased at T1 and decreased at T2(F=10.450,P<0.05).Compared with T0,SBP decreased at T2 in the observation group(F=5.857,P<0.05).At T1,the HR of the observation group was slower than that of the control group(P<0.01),and both SBP and DBP were lower than those of the control group(both P<0.01).At T2,HR of the observation group was slower than that of the control group(P<0.05),and both SBP and DBP were higher than those of the control group(P<0.05).Compared with the control group,the incidence of hypertension,hypotension,rapid atrial fibrillation complicated with hypotension in the observation group were lower(P<0.05).Conclusion Under general anesthesia,LAAC is safe and feasible for elderly patients with atrial fibrillation.Laryngeal surface anesthesia may be conducive to maintaining circulation stability and reducing the occurrence of cardiovascular adverse events such as rapid atrial fibrillation.

关 键 词：老年 表面麻醉 全身麻醉 心房颤动 左心耳封堵术 

分 类 号：R614[医药卫生—麻醉学]