急诊经导管主动脉瓣置换术的麻醉管理与处置策略  

Clinical study of anesthesia management and treatment strategies for emergency transcatheter aortic valve replacement

作　　者：何伟[1] 刘羿 刘先宝[2] 孔敏坚[3] 林心平 丁敏君[3] 程继芳[1] 严敏[1] He Wei;Liu Yi;Liu Xianbao;Kong Minjian;Lin Xinping;Ding Minjun;Cheng Jifang;Yan Min(Department of Anesthesia,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Cardiology,the Second Ajfiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Cardiovascular Surgery,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院麻醉手术部,杭州310009 [2]浙江大学医学院附属第二医院心血管内科,杭州310009 [3]浙江大学医学院附属第二医院心脏大血管外科,杭州310009

出　　处：《中华急诊医学杂志》2022年第7期944-947,共4页Chinese Journal of Emergency Medicine

摘　　要：目的论述急诊经导管主动脉瓣置换术(transcatheter aortic valve replacement, TAVR)的麻醉管理要点和处置策略, 为我国急诊TAVR技术的成熟提供规范化的建议。方法本研究回顾性分析了2019年3月到2021年2月期间在浙江大学医学院附属第二医院接受急诊TAVR手术的患者相关资料, 包括患者的基本术前资料、围术期心脏超声数据、预后及30 d随访等数据, 并配对比较了患者术后资料与术前资料。结果 13例患者接受了急诊TAVR手术, 其中患者年龄(75.62±9.63)岁, 其中男性6例。11例纽约心脏协会评级Ⅳ级。术前美国胸外科医生协会评分(20.31±15.15)%, 术后跨主动脉瓣压差明显降低[(68.92±30.66)mmHgvs.(2.70±2.36)mmHg, P<0.01], 术后30 d内2例患者死亡, 1例患者出现新发Ⅲ度房室传导阻滞、1例患者出现中风、4例患者出现肺部感染。结论对于主动脉瓣狭窄患者出现危急状况时, 急诊TAVR手术是一项可行且有效的抢救策略, 建立TAVR手术麻醉标准作业流程有助于保证同质化的医疗行为以及良好的团队合作。Objective To discuss the essentials of anesthesia management and treatment strategies for emergency transcatheter aortic valve replacement(TAVR),and to provide standardized recommendations for the development of emergency TAVR technology in China.Methods This study retrospectively analyzed the relevant data of patients undergoing emergency TAVR surgery in the Second Affiliated Hospital of Zhejiang University School of Medicine from March 2019 to February 2021,including baseline patient characteristics,perioperative echocardiography data,prognosis and 30-day follow-up.Post-operative data were compared with pre-operative data using paired-sample test.Results Thirteen patients,aged(75.62±9.63)years,underwent emergency TAVR surgery,and 6 of them were male.Eleven patients were New York Heart Association class IV.The preoperative Society of Thoracic Surgeons score was(20.31±15.15)%.The trans-aortic valve differential pressure was significantly reduced after surgery[(68.92±30.66)mmHg vs.(2.70±2.36)mmHg P<0.01].Two patients died within 30 days after surgery,one patient developed a new third degree atrioventricular block,one patient had a stroke,and 4 patients developed pulmonary infection.Conclusions Emergency TAVR surgery is a feasible and effective rescue strategy for patients with aortic stenosis in critical condition.The establishment of anesthesia standard operation procedure process for TAVR surgery helps ensure homogenized medical behavior and good teamwork.

关 键 词：主动脉瓣狭窄 急诊 经导管主动脉瓣置换术 

分 类 号：R614[医药卫生—麻醉学]