摘要
目的探讨气管插管全身麻醉在经导管主动脉瓣植入术(transcatheter aortic valve implantation,TAVI)中的安全性和可行性,以及TAVI的麻醉管理要点。方法选择2012年9月—2013年6月在四川大学华西医院接受TAVI治疗的主动脉狭窄患者25例,麻醉方式采用气管插管全身麻醉,记录麻醉诱导前、麻醉诱导后、手术开始前、快速心室起搏期间、主动脉瓣置入前、主动脉瓣置入后、术后各阶段血流动力学、血气分析、氧饱和度等参数,记录TAVI围手术期并发症发生率和术后30 d内病死率。结果 25例患者均成功置入人工主动脉瓣,其中2例患者置入人工瓣膜后出现中度瓣周反流,遂再次置入第2枚人工瓣膜。所有患者均对全身麻醉耐受良好,未出现麻醉相关并发症。新发或原有传导阻滞加重19例,安置永久起搏器7例;围手术期出血2例;脑血管意外2例;死亡1例。结论气管插管全身麻醉可以安全地用于TAVI患者中。TAVI手术是需要多学科密切合作的富有挑战的治疗手段,麻醉医生可在TAVI术中评估和决策里担当更多领导的角色。
Objective To explore the safety and feasibility of general anesthesia with tracheal intubation in transcatheter aortic valve implantation （TAVI）, and the key points in anesthetic management. Methods Twenty-five patients with aortic stenosis treated by TAVI in West China Hospital of Sichuan University between September 2012 and June 2013 were included in this study. General anesthesia with tracheal intubation was chosen. We recorded and analyzed the hemodynamics, blood gas, oxygen saturation data before and after anesthesia induction, before surgery, during rapid ventricular pacing, before and after aortic valve implantation. Besides, the incidence of perioperative complications and 30-day mortality were also recorded. Results All the 25 patients underwent the implantation surgery successfully. Two patients had the second implantation surgery due to moderate reflux. All the subjects in this study tolerated general anesthesia well without any anesthesia-related complications. There were 19 cases of newly developed or aggravated heart blocks, 7 of permanent pace maker, 2 of perioperative hemorrhage, 2 of cerebral vascular events, and 1 death case. Conclusioins General anesthesia with tracheal intubation can be utilized safely in patients undergoing TAVI. TAVI is a challenging technique in need of precise collaborations of multi-disciplines, in which anesthetists should play more as a leader in evaluation and decision-making during the surgery.
出处
《华西医学》
CAS
2017年第4期554-558,共5页
West China Medical Journal
关键词
经导管主动脉瓣植入术
麻醉管理
主动脉狭窄
Transcatheter aortic valve implantation
Anesthetic management
Aortic stenosis
