51例经心尖经导管主动脉瓣置换术的麻醉经验总结  

Anesthesia Management for 51 Cases Undergoing Transapical Transcatheter Aortic Valve Replacement

作　　者：石晟[1] 杨丽静[1] 雷桂玉 王旭[2] 王剑辉[1] SHI Sheng;YANG Li-jing;LEI Gui-yu;WANG Xu;WANG Jian-hui(Department of Anesthesiology,Fuwai Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,National Center for Cardiovascular Diseases,State Key Laboratory of Cardiovascular Disease,Beijing 100037,China;Department of Anesthesiology,Beijing Tongren Hospital,Beijing 100730,China)

机构地区：[1]北京协和医学院国家心血管病中心,心血管疾病国家重点实验室中国医学科学院阜外医院麻醉科,北京市100037 [2]北京协和医学院国家心血管病中心,心血管疾病国家重点实验室中国医学科学院阜外医院心脏外科,北京市100037 [3]首都医科大学附属北京同仁医院麻醉科,北京市100730

出　　处：《中国分子心脏病学杂志》2021年第2期3865-3868,共4页Molecular Cardiology of China

摘　　要：目的回顾性总结经心尖经导管主动脉瓣置换术(TA-TAVR)的麻醉方法和围术期麻醉管理经验。方法纳入2014年7月至2020年6月在我院行TA-TAVR的患者,记录术前、术中及术后的相关临床资料,对麻醉方法及围术期并发症的预防及管理进行分析总结。结果共纳入51例患者,平均年龄(76.24±5.28)岁,手术均在全身麻醉下完成,应用血管活性药物治疗者45例(88.23%);术后机械通气时间23(16:40)h,ICU停留时间2(1:4)d,术后住院时间(13.25±8.47)d;术中紧急开胸6例(11.76%),术中死亡2例(3.92%),院内死亡3例(5.89%),主要并发症包括急性肾损伤、心肌梗死、中风、Ⅲ°房室传导阻滞及主动脉夹层。结论经心尖途径的TAVR手术由于创伤大、围术期风险高,需要在全身麻醉下进行,术中要求维持血流动力学的平稳并及时识别和处理并发症。Objective To retrospectively analyze the anesthesia methods and perioperative anesthesia management experiences of transapical transcatheter aortic valve replacement(TA-TAVR).Methods We reviewed all patients undergoing TA-TAVR in our hospital from June 2014 to July 2020.All perioperative clinical data were recorded and analyzed.Results A total of 51 patients with the mean age of(76.24±5.28)years were enrolled.The anesthesia method was general anesthesia.45 patients(88.23%)were treated with vasoactive agents;the postoperative mechanical ventilation time was 23(16:40)h,ICU stay was 2(1:4)d,and the length of postoperative hospital stay was(13.25±8.47)d;among them,6 cases(11.76%)underwent emergency thoracotomy,2 cases(3.92%)died during operation,and 3 cases(5.89%)died in hospital.The main complications included acute kidney injury,myocardial infarction,stroke,III°atrioventricular block and aortic dissection.Conclusion TA-TAVR needs to be performed under general anesthesia because of severe trauma and high perioperative risk.Anesthesia management process should focus on hemodynamic management and timely identify and deal with complications.

关 键 词：经导管主动脉瓣置换术 经心尖经导管主动脉瓣置换术 麻醉管理 

分 类 号：R614[医药卫生—麻醉学]