经导管主动脉瓣置换术介入手术室的安全管理  

Safe management of transcatheter aortic valve replacement intervention in operating room

作　　者：李亚丽[1] 彭成丽[1] 佘淑铭 常莉 南永远 李仕昊 陈玉新 LI Ya-li;PENG Cheng-li;SHE Shu-ming;CHANG li;NAN Yong-yuan;LI Shi-hao;CHENG Yu-xin(Interventional Operation Room,Henan Provincial Chest Hospital,Zhengzhou 450007,China;Department of Cardiovascular Surgery,Great Vascular Center,Henan Provincial Chest Hospital,Zhengzhou 450007,China)

机构地区：[1]河南省胸科医院介入手术室,郑州450007 [2]河南省胸科医院心脏大血管中心心血管外科,郑州450007

出　　处：《医药论坛杂志》2023年第10期28-30,35,共4页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210231)。

摘　　要：目的 对经导管主动脉瓣置换术(TAVR)围手术期介入手术室安全管理的流程探索和经验总结。方法 选取河南省胸科医院2020年9月—2021年7月完成的TAVR手术患者64例,优化规范TAVR手术过程中安全管理。结果 63例痊愈出院,1例术中因升主动脉破裂紧急转外科手术,术后25天因脓毒血症、多脏器功能衰竭死亡。术中并发症发生率6.25%,除上述死亡病例外,其余术中出现并发症和紧急情况病例均经积极处理后痊愈出院。随访12~16月,所有出院患者均心功能较术前改善明显,均可胜任日常活动,无死亡病例出现。术中并发症升主动脉破裂1例,室颤1例,重度瓣周漏1例。术中紧急处理情况有急诊外科开胸手术1例,电除颤1例,紧急PCI1例,瓣中瓣1例,ECMO辅助1例,无永久起搏器安置病例。结论 规范化的TAVR介入手术室安全管理,可降低TAVR手术风险。Objective To explore and summarize the process and experience of safety management in transcatheter aortic valve replacement(TAVR)perioperative intervention operating room.Methods Totally 64 patients with TAVR surgery completed in Henan Provincial Chest Hospital from September 2020 to July 2021 were selected to optimize and standardize the safety management during TAVR surgery.Results Totally 63 cases were cured and discharged from hospital.1 case was transferred to surgery due to rupture of ascending aorta,and died of sepsis and multiple organ failure 25 days after operation.The incidence of intraoperative complications was 6.25%.Except for the above death cases,other intraoperative complications and emergency cases were recovered and discharged after active treatment.After 12-16 months of follow-up,the cardiac function of all discharged patients was significantly improved compared with that of before surgery,and they were all competent for daily activities.No death cases occurred.Intraoperative complications:ascending aorta rupture in 1 case,ventricular fibrillation in 1 case and severe perivalvular leakage in 1 case.Intraoperative emergency treatment included 1 case of emergency surgical thoracotomy,1 case of electrical defibrillation,1 case of emergency PCI,1 case of middle valve,1 case of ECMO assistance and no case of permanent pacemaker placement.Conclusion Standardized safety management of TAVR intervention operation room can reduce the risk of TAVR operation.

关 键 词：AVR 手术室 安全管理 

分 类 号：R654.2[医药卫生—外科学]