在单纯局部麻醉下行经导管主动脉瓣置换术可行性和安全性的初步研究  

Feasibility and Safety of Transfemoral Transcatheter Aortic Valve Replacement Under Pure Local Anesthesia

作　　者：赵振燕[1] 张洪亮[1] 张喆[2] 袁素[2] 王墨扬[1] 牛冠男[1] 叶蕴青[1] 周政 张倩[1] 王彬成 陈阳[1] 孟真 赵杰[1] 吴永健[1] ZHAO Zhenyan;ZHANG Hongliang;ZHANG Zhe;YUAN Su;WANG Moyang;NIU Guannan;YE Yunqing;ZHOU Zheng;ZHANG Qian;WANG Bincheng;CHEN Yang;MENG Zhen;ZHAO Jie;WU Yongjian(Coronary Heart Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院冠心病中心,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院麻醉中心,北京市100037

出　　处：《中国循环杂志》2022年第4期341-347,共7页Chinese Circulation Journal

基　　金：国家重点研发计划(2020YFC2008100)。

摘　　要：目的:本研究观察在单纯局部麻醉(局麻)下行经导管主动脉瓣置换术(TAVR)的安全性及可行性。方法:连续入选2021年3月至2021年9月我院计划在单纯局麻下行TAVR治疗的患者共72例。观察手术成功率、心功能改善及并发症发生情况,随访30 d内主要不良心脏事件的发生情况。结果:72例患者均成功置入TAVR人工瓣膜,根据瓣膜学术研究联盟(VARC)-3定义,总的手术成功率和30 d器械植入成功率均为80.6%(58/72)。其中,63例(87.5%)患者行单纯局麻下TAVR,2例(2.8%)因股动脉穿刺口部损伤和纳入临床试验改为全身麻醉,7例(9.7%)患者由单纯局麻改为局麻+镇静;共6例(8.3%)因并发症和术中不适症状更改麻醉方式。与术前相比,患者术后NYHA心功能分级明显改善(P<0.001)。72例患者中,术后30 d内因急性心肌梗死死亡1例(1.4%),出现急性脑卒中1例(1.4%)、血管并发症3例(4.2%)、新发起搏器植入5例(6.9%),无急性肾损伤、瓣膜移位、中度及以上瓣膜反流等情况。结论:在单纯局麻下行TAVR安全、可行,是局麻+镇静麻醉TAVR的进一步简化。Objectives:In clinical practice,local anesthesia with conscious sedation or general anesthesia is routinely performed in patients undergoing transcatheter aortic valve replacement(TAVR).However,the safety and efficacy of pure local anesthesia(without conscious sedation)with TAVR are not known.Methods:This observational analysis was performed in 72 patients undergoing transfemoral TAVR in Fuwai Hospital between March 2021 and September 2021.The patients assigned to receive pure local anesthesia during the procedure of TAVR were included.The effectiveness of pure local anesthesia was evaluated during and after TAVR.The primary efficacy endpoint was consisted of the composite of all-cause mortality,stroke,myocardial infarction,major vascular complications and acute kidney injury at 30 days.Results:All patients were successfully implanted prosthetic valves.According to the endpoint definitions of Valve Academic Research Consortium 3,the technical success and device success of TAVR at 30 days were both 80.6%(58/72).63(87.5%)patients received pure local anesthesia,2 cases(2.8%)received general anesthesia due to injury at puncture site of femoral artery and enrolled for another clinical trial,7 cases(9.7%)received local anesthesia plus conscious sedation(type of anesthesia was changed in 6 cases[8.3%]due to complications and intolerance during TAVR).NYHA classification was significantly improved after TAVR(P<0.001).At 30 days,intent-to-treatment analysis showed that all-cause mortality was 1.4%(1/72),stroke incidence was 1.4%(1/72),myocardial infarction incidence was 1.4%(1/72),major vascular complications incidence was 4.2%(3/72)and the permanent pacemaker implantation rate was 6.9%(5/72).There was no acute kidney injury and serious perivalvular leakage post TAVR.Hemodynamics index were improved immediately,at 1 month and 6 months after TAVR.Conclusions:Transfemoral TAVR can be safely performed with pure local anesthesia.Pure local anesthesia without conscious sedation is a simpler mode of anesthesia for patients under

关 键 词：单纯局部麻醉 经导管主动脉瓣置换术 安全性 可行性 

分 类 号：R54[医药卫生—心血管疾病]