经导管二尖瓣缘对缘修复术的超快通道麻醉经验总结  

Ultra-fast track anesthesia management for transcatheter mitral valve edge-to-edge repair

作　　者：邹志瑶 朱达 陈一鸣 王首正[3] 高建斌 董靖 潘湘斌[3] 杨克 ZOU Zhi-yao;ZHU Da;CHEN Yi-ming;WANG Shou-zheng;GAO Jian-bin;DONG Jing;PAN Xiang-bin;YANG Ke(Department of Anesthesiology,Fuwai Yunnan Hospital,Chinese Academy of Medical Sciences,Affi liated Cardiovascular Hospital of Kunming Medical University,Kunming 650102,China;Department of Structure Heart Center,Fuwai Yunnan Hospital,Chinese Academy of Medical Sciences,Affi liated Cardiovascular Hospital of Kunming Medical University,Kunming 650102,China;Department of Structure Heart Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical,Beijing 100037,China)

机构地区：[1]云南省阜外心血管病医院,昆明医科大学附属心血管医院麻醉科,昆明650102 [2]云南省阜外心血管病医院,昆明医科大学附属心血管医院结构性心脏病中心,昆明650102 [3]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院结构性心脏病中心,北京100037

出　　处：《中国介入心脏病学杂志》2024年第5期250-256,共7页Chinese Journal of Interventional Cardiology

基　　金：“十四五”重点研发计划项目(2022YFC2503400);云南省心血管系统疾病临床医学研究中心-重大心血管疾病诊治新技术研发项目(202102AA310002);云南省重大科技专项计划项目(202302AA310045);云南省科学技术厅昆明医科大学应用基础研究联合专项项目(202301AY070001-044)。

摘　　要：目的回顾性总结超快通道麻醉应用于经导管二尖瓣缘对缘修复术(TEER)治疗功能性二尖瓣反流患者的麻醉方法和围术期麻醉管理经验。方法纳入2022年5—9月在云南省阜外心血管病医院因心力衰竭合并中重度或重度功能性二尖瓣反流行TEER手术,且实施超快通道麻醉的患者。收集患者一般资料、术前合并症、心功能及麻醉分级、术前及术后1年经食管超声心动图检查结果、血清N末端B型脑钠肽前体(NT-proBNP)、手术及拔除气管导管时间、术中麻醉用药、手术及麻醉相关并发症。对麻醉管理、围术期并发症的预防及管理进行分析总结。结果共纳入30例患者,女11例(36.7%),年龄(63.6±6.1)岁。术前纽约心脏病协会(NYHA)心功能分级Ⅳ级14例(46.7%);左心室射血分数(36.0±8.1)%,左心室舒张末期前后径(66.0±8.2)mm;二尖瓣反流程度4+:17例(56.7%),3+:13例(43.3%);NT-proBNP(1934.1±1973.5)pg/ml;采用超快通道麻醉的患者中,有1例(3.3%)患者术中使用大剂量血管活性药。30例患者术后24 h均未发生恶心、呕吐、谵妄、呼吸抑制、围术期经食管超声心动图检查相关消化道大出血、心包积液、脑血管意外、需紧急手术或二次干预及其他术中严重不良事件;无30 d全因死亡发生,平均术后住院(7.4±2.8)d。所有患者完成术后1年随访:左心室射血分数(37.6±11.1)%,左心室舒张末期前后径(63.2±8.6)mm;二尖瓣反流程度2+:7例(23.3%),1+:23例(76.7%);NT-proBNP(1949.2±2576.6)pg/ml。结论超快通道麻醉可应用于TEER治疗功能性二尖瓣反流患者。Objective To retrospectively analyze the ultra-fast track anesthesia(UFTA)5methods and perioperative anesthesia management experiences of transcatheter mitral valve edge-to-edge repair(TEER)in the treatment of functional mitral regurgitant.Methods In this retrospective study,patients underwent the TEER procedure and received UFTA in Fuwai Yunnan Hospital,from May 2022 to September 2022 for heart failure combined with moderate to severe or severe functional mitral regurgitant were included.Baseline,preoperative complications,cardial function and anesthesia classifi cation,amino-terminal probrain natriuretic peptide(NT-proBNP),ultrasound examination results,surgery time,extubation time,intraoperative anesthetic and vasoactive drug,complications related to TEER and UFTA,perioperative,and postoperative 30-day and one-year follow-up data were collected.All perioperative clinical data were recorded and analyzed.Results A total of 30 patients were enrolled,11 patients(36.7%)were female,mean age was(63.6±6.1)years,NYHA classifi cationⅣ14 patients(46.7%),left ventricular ejection fraction(LVEF)(36.0±8.1)%,the end-diastolic volume of the left ventricle(66.0±8.2)mm,mitral regurgitation 4+14 patients(56.7%),3+17 patients(43.3%),NT-proBNP(1934.1±1973.5)pg/ml,1 patient(3.3%)used high-dose vasoactive drugs during surgery.All patients did not experience nausea,vomiting,delirium,respiratory depression,perioperative transesophageal echocardiography-related gastrointestinal bleeding,pericardial eff usion,cerebrovascular accidents,emergency surgery or secondary intervention,or other serious adverse events within 24 hours after surgery.No 30-day all-cause death occurred;the mean postoperative hospital stay was(7.4±2.8)days.All patients completed one-year follow-up,LVEF(37.6±11.1)%,the end-diastolic volume of the left ventricle(63.2±8.6)mm,mitral regurgitation 2+7 patients(23.3%),1+23 patients(76.7%),NT-proBNP(1949.2±2576.6)pg/ml.Conclusions Ultra-fast track anesthesia can be safely applied to TEER in treating functional mit

关 键 词：功能性二尖瓣反流 二尖瓣缘对缘介入修复 麻醉管理 超快通道麻醉 

分 类 号：R541[医药卫生—心血管疾病]