心肺转流在一站式TAVR+PCI中的应用  

Application of cardiopulmonary bypass in one-stop TAVR+PCI

作　　者：张航[1] 王华君 石凤梧[1] 刘苏[1] 马千里[1] 安景辉[1] ZHANG Hang;WANG Huajun;SHI Fengwu;LIU Su;MA Qianli;AN Jinghui(Department of Cardiac Surgery,Second Hospital of Hebei Medical University,Shijiazhuang,050000,China)

机构地区：[1]河北医科大学第二医院心脏外科,石家庄050000

出　　处：《临床心血管病杂志》2024年第12期1012-1015,共4页Journal of Clinical Cardiology

摘　　要：目的:探讨心肺转流(CPB)在一站式经导管主动脉瓣置换(TAVR)+经皮冠状动脉介入治疗(PCI)中的应用,并总结相关经验。方法:收集2016年1月—2024年5月于河北医科大学第二医院行一站式TAVR+PCI患者的临床资料,根据术中是否计划应用CPB将患者分为CPB组和非CPB组,并对两组的围手术期资料进行回顾性分析。结果:共纳入患者52例,其中CPB组40例,非CPB组12例;CPB组术中建立而未开放CPB的有35例,建立且开放CPB的有5例(CPB的实际应用率为12.5%)。50例患者完成手术,2例(3.8%)患者术中死亡(均在非CPB组)。术中实施经外周TAVR 48例,经心尖TAVR 2例;术中PCI成功开通单支冠状动脉狭窄38例,开通两支冠状动脉狭窄12例。50例患者术后临床症状均较术前存在不同程度的改善。两组在中转开胸、瓣中瓣置入、中度及以上瓣周反流、新发传导阻滞、低心排综合征等并发症发生率方面差异无统计学意义。两组在术后呼吸机辅助时间、ICU监护时间、术后住院时间方面差异无统计学意义。结论:CPB在一站式TAVR+PCI中的应用可获得满意的临床疗效,值得进一步尝试和推广。Objective:To explore the role of cardiopulmonary bypass(CPB)in transcatheter aortic valve replacement(TAVR).The application of TAVR+percutaneous coronary intervention(PCI),and the relevant experience were summarized.Methods:Clinical data of patients undergoing one-stop TAVR+PCI in the Second Hospital of Hebei Medical University from January 2016 to May 2024 were collected,and the patients were divided into CPB group and non-CPB group according to whether CPB was used during the operation,and the perioperative data of the two groups were retrospectively analyzed.Results:There were 40 cases in the CPB group and 12 in the non-CPB group.In the CPB group,there were 35 cases in which CPB was established but not opened,and 5 cases in which CPB was established and opened(the actual application rate of CPB was 12.5%).Fifty patients completed surgery,and 2 patients(3.8%)died intraoperatively(all in the non-CPB group).Perioperative TAVR was performed in 48 cases and transapical TAVR in 2 cases.Intraoperative PCI successfully opened single coronary artery stenosis in 38 cases and double coronary artery stenosis in 12 cases.The clinical symptoms of all the 50 patients were improved to different degrees after operation.There was no significant difference in the incidence of complications such as conversion to thorax opening,midvalve insertion,moderate or above perivalvular regurgitation,new conduction block and low cardiac production syndrome between the two groups.There was no significant difference between the two groups in postoperative ventilator assistance time,ICU monitoring time and postoperative hospitalization time.Conclusion:The application of CPB in one-stop TAVR+PCI can obtain satisfactory clinical efficacy.

关 键 词：经导管主动脉瓣置换术 经皮冠状动脉介入治疗 心肺转流 

分 类 号：R541.4[医药卫生—心血管疾病]