经导管主动脉瓣置换术中循环崩溃的危险因素及紧急处理策略  

Risk Factors and Emergency Management Strategies for Hemodynamic Collapse During Transcatheter Aortic Valve Replacement

作　　者：张韶鹏 陈庆良[1] 赵丰[1] 付博 张玉辉 白云鹏 陈彤云[1] 姜楠[1] ZHANG Shaopeng;CHEN Qingliang;ZHAO Feng;FU Bo;ZHANG Yuhui;B AI Yunpeng;CHEN Tongyun;JIANG Nan(Department of Cardiovascular Surgery,Tianjin Chest Hospital,Tianjin(300051),China)

机构地区：[1]天津市胸科医院心血管外科,300051

出　　处：《中国循环杂志》2022年第4期399-404,共6页Chinese Circulation Journal

基　　金：国家重点研发计划(2020YFC2008100);天津市医学重点学科(专科)建设项目。

摘　　要：目的:研究经导管主动脉瓣置换术(TAVR)术中发生循环崩溃的危险因素,并制定相应的紧急处理策略。方法:回顾性分析2019年1月至2021年8月于天津市胸科医院行TAVR的165例患者,其中无循环崩溃组146例,循环崩溃组19例。比较两组患者基线资料,采用Logistic回归分析评价术中循环崩溃的危险因素。结果:本组病例中,TAVR术中循环崩溃的发生率为11.52%(19/165),其中63.16%(12/19)患者接受体外循环辅助。循环崩溃组中合并衰弱、美国胸外科医师协会(STS)评分≥8%、左心室射血分数(LVEF)≤30%,二尖瓣中度以上反流的患者比例均较无循环崩溃组更高(P均<0.05)。循环崩溃组患者死亡率远高于无循环崩溃组(15.79%vs.2.06%,P=0.021)。多因素Logistic回归分析结果提示,经心尖入路(OR=12.542,95%CI:1.183~133.008,P=0.036)、二尖瓣中度以上反流(OR=22.483,95%CI:3.703~136.505,P=0.000)和LVEF≤30%(OR=13.904,95%CI:2.420~79.875,P=0.003)与TAVR术中循环崩溃相关。结论:经心尖入路、二尖瓣中度以上反流和LVEF≤30%是TAVR术中循环崩溃的独立危险因素。术前详尽的准备和科学有效的应急预案,能够有效提高救治成功率。Objectives:This study aimed to investigate the risk factors of hemodynamic collapse during transcatheter aortic valve replacement(TAVR),and to formulate corresponding emergency management strategies.Methods:A total of 165 patients,who underwent TAVR surgery in Tianjin Chest Hospital from January 2019 to August 2021,were included in this retrospective study.There were 19 patients in the collapse group and 146 in the non-collapse group.The baseline data of the two groups were compared,and logistic regression analysis was used to evaluate the risk factors of intraoperative hemodynamic collapse.Results:The incidence of intraoperative circulatory collapse was 11.52%(19/165),of which 63.16%(12/19)patients received cardiopulmonary bypass assistance.Percent of patients with weakness,STS score≥8,left ventricular ejection fraction(LVEF)≤30%,moderate or severe mitral regurgitation were significantly higher in the collapse group than in the noncollapse group(all P<0.05).The mortality of patients was much higher in the collapse group than that in the non-collapse group(15.79%vs.2.06%,P=0.021).Multivariate logistic regression analysis showed that transapical approach(OR=12.542,95%CI:1.183-133.008,P=0.036),moderate or severe mitral regurgitation(OR=22.483,95%CI:3.703-136.505,P=0.000)and LVEF≤30%(OR=13.904,95%CI:2.420-79.875,P=0.003)were independent risk factors of hemodynamic collapse during TAVR.Conclusions:Transapical approach,moderate or severe mitral regurgitation and LVEF≤30%are the independent risk factors of hemodynamic collapse during TAVR.Detailed preoperative preparation and effective emergency strategies could effectively improve the success rate of rescuer for patients with hemodynamic collapse during TAVR.

关 键 词：经导管主动脉瓣置换术 并发症 血流动力学 循环辅助 体外膜肺氧合 

分 类 号：R54[医药卫生—心血管疾病]