胸腹主动脉腔内修复手术的麻醉管理和脏器保护方法:阜外经验  

Anesthesia and Organ Protection of Thoracic and Infradiaphragmatic Endovascular Repair: a Single-centerExperience in Fuwai Hospital

作　　者：赵婉 刘广宇 袁素 ZHAO Wan;LIU Guangyu;YUAN Su(Department of Anesthesiology,Fuwai Hospital,National Center of Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院、北京协和医学院、阜外医院、国家心血管病中心麻醉中心,北京市100037

出　　处：《中国分子心脏病学杂志》2023年第2期5284-5292,共9页Molecular Cardiology of China

基　　金：中央高水平医院临床科研业务费资助(2022-GSP-GG-36)。

摘　　要：目的总结急性主动脉综合征、胸腹主动脉瘤患者择期进行胸主动脉腔内修复术(TEVAR)和/或腹主动脉腔内修复术(EVAR)的麻醉管理和脏器保护方法。方法收集2021年1月1日至12月31日在阜外医院择期进行TEVAR/EVAR的473例患者的相关临床资料进行回顾性分析。其中303例(64.1%)患者接受TEVAR,170例患者(35.9%)接受EVAR。对两组患者的麻醉方法及围手术期并发症的预防和管理经验进行分析和总结。结果本组患者在全身麻醉下完成手术455例(96.2%),采用镇静或监护麻醉管理(MAC)18例(3.8%)。术后机械通气时间0(0,5)h,重症监护病房(ICU)停留时间21(18,23)h,平均住院时间(10.5±3.8)d。术后发生脊髓缺血3例(0.6%),急性脑卒中3例(0.6%),急性肾损伤9例(1.9%),心血管并发症6例(1.3%),入路血管和主动脉再次干预10例(2.1%),非康复出院4例(0.8%),无院内死亡病例。结论全身麻醉是TEVAR/EVAR最常用的麻醉方式,最佳的麻醉方案是术毕在手术室拔管,应重点关注围手术期血流动力学管理,神经系统、心脏、腹腔脏器的保护是麻醉处理的关键。Objective To retrospectively analyze the anesthesia and organ protection strategy during elective thoracic endovascular aortic repair(TEVAR)/endovascular aortic repair(EVAR)in patients with acute aortic syndromes or abdominal aortic aneurysm(AAA).Methods Perioperative clinical data of 473 patients undergoing elective TEVAR/EVAR in Fuwai hospital from January 1,2021 to December 31,2021 were recorded and analyzed,including 303 patients(64.1%)undergoing TEVAR and 170 patients(35.9%)undergoing EVAR.Results Totally 455 patients undergoing general anesthesia,accounting for 96.2%.The postoperative mechanical ventilation time was 0(0,5)h,intensive care unit(ICU)stay was 21(18,23)h,and the length of hospital stay was(10.5±3.8)d.There were 3 cases of spinal cord ischemia(SCI),3 cases of acute stroke,9 cases of acute kidney injury(AKI),6 cases of cardiovascular complications,10 cases of re-intervention on vascular access or aorta,4 cases discharged from the hospital without recovery,and no mortality after operation.Conclusion General anesthesia is usually preferred in patients undergoing TEVAR/EVAR.And early tracheal extubation after operation is recommended.Anesthesia management should focus on hemodynamic management,spinal cord,cerebral,kidney and cardio protection.

关 键 词：胸主动脉腔内修复术 腹主动脉腔内修复术 麻醉管理 脏器保护 

分 类 号：R614[医药卫生—麻醉学]