加速康复外科在经导管主动脉置入术患者应用的结果分析  

Results of application of enhanced recovery after surgery in patients undergoing transcatheter aortic valve implantation

作　　者：王艳超 许斌[1] 李晓萌 王生伟 来永强[2] WANG Yanchao;XU Bin;LI Xiaomeng;WANG Shengwei;LAI Yongqiang(Operating Room of Anesthesia Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所麻醉中心手术室,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所结构性外科中心,100029

出　　处：《心肺血管病杂志》2024年第11期1185-1189,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都卫生发展科研专项(首发2020-1-1053)。

摘　　要：目的:通过回顾性分析我院股动脉入路经导管主动脉瓣置换术(transcatheter aortic valve implantation,TAVI)的临床资料,研究加速康复外科在其中的应用,分析其实施失败的原因并确定其危险因素。方法:回顾性分析2019年1月至2023年2月在北京安贞医院行股动脉入路TAVI的117例患者的临床资料。其中在手术室成功拔管或回ICU后2小时内拔管患者定义为加速康复外科组,包括59例患者,其中男性31例、女性28例,平均年龄(73.3±7.9)岁;同期加速康复外科实施失败患者作为非加速康复外科组,共包括58例患者,男性33例、女性25例,平均年龄(76.2±5.7)岁。结果:两组患者在手术时间、气管插管拔管时间、中度以上瓣周漏、ICU停留时间、术后住院时间以及住院总费用(P<0.05)方面存在明显差异,通过Logistic回归分析发现,在经性别及年龄等校正后,术前心功能分级较低和NT-B型钠尿肽水平高是影响患者早期拔管的独立危险因素。结论:加速康复外科的成功实施,对于TAVI术的围术期护理具有重要意义,可以减少围术期并发症、缩短住院时间以及降低医疗费用等方面具有明显优势,而射血分数的降低和NT-proBNP水平的增高是影响该类患者实施加速外科康复的危险因素。Objective:To retrospectively analyze the clinical data of patients with transcatheter aortic valve implantation(TAVI)via femoral artery approach in our hospital,study the application of accelerated rehabilitation surgery,analyze the reasons for its implementation failure,and determine its risk factors.Methods:A retrospective analysis was conducted on the clinical data of 117 patients who underwent femoral artery approach TAVI at Beijing Anzhen Hospital from January 2019 to February 2023.Among them,patients who were successfully extubated in the operating room or within 2 hours after returning to the ICU were defined as the accelerated rehabilitation surgery group,including 59 patients,including 31 males and 28 females,with an average age of(73.3±7.9)years;Patients who failed to undergo accelerated rehabilitation surgery during the same period were included in the non-accelerated rehabilitation surgery group,consisting of 58 patients,including 33 males and 25 females,with an average age of(76.2±5.7)years.Results:There were significant differences between the two groups of patients in terms of surgical time,tracheal intubation and extubation time,moderate to severe perivalvular leakage,ICU stay time,postoperative hospitalization time,and total hospitalization costs(P<0.05).Logistic regression analysis showed that after adjusting for gender and age,low preoperative cardiac function grading and high levels of NT-proBNP were independent risk factors affecting early extubation in patients.Conclusion:The successful implementation of accelerated rehabilitation surgery is of great significance for perioperative nursing of TAVI surgery,which can reduce perioperative complications,shorten hospitalization time,and lower medical costs.However,the decrease in ejection fraction and the increase in NT-proBNP levels are risk factors affecting the implementation of accelerated surgical rehabilitation in such patients.

关 键 词：经导管主动脉瓣置换 加速康复 危险因素 

分 类 号：R54[医药卫生—心血管疾病]