摘要
目的比较气管插管(ETT)和喉罩(LMA)在全身麻醉下行射频消融治疗心房颤动(房颤)中的临床效果及费用。方法本研究为单中心队列研究。选取2022年7月至12月在北京朝阳医院心内科首次接受射频消融治疗的房颤患者, 房颤射频消融患者采用LMA麻醉(LMA麻醉组)或ETT麻醉(ETT麻醉组)进行气道管理。比较两组患者术中血流动力学、麻醉时间、消融时间、术后并发症发生情况及费用情况。结果共纳入120例患者, 其中男82例, 女38例, 年龄(65.0±1.2)岁。LMA麻醉组(60例)血流动力学更稳定, 应用去甲肾上腺素剂量低于ETT麻醉组[(0.035±0.006 )μg·kg^(-1)·min^(-1)对(0.003±0.004)μg·kg^(-1)·min^(-1), P<0.001]。LMA麻醉组患者手术时间[(143.00±4.46)min对(158.00±5.51)min, P=0.035、麻醉时间[(158.83±4.91)min对(183.67±5.98)min, P=0.002]、消融时间(1 442.70±87.97)s对(1 866.06±75.40)s, P<0.001、意识恢复时间(16.96±0.37)min对(5.53±0.27)min, P<0.001)和麻醉恢复时间(33.03±0.55)min对(14.70±0.47)min, P<0.001)均短于ETT麻醉组。LMA麻醉组术后咽痛(3%对40%, P<0.001)、声音嘶哑(3%对30%, P<0.001)和恶心(6%对43%, P<0.001)的发生率也较低。ETT麻醉组异丙酚[(26.67±1.37)mg对(19.86±0.81)mg, P<0.001]和瑞芬太尼[(20.36±1.28)mg对(17.06±0.96)mg, P=0.044]剂量较高。由于ETT组的设备费用贵和麻醉护理时间较长, 总费用增加了约12%[(98 912.04±1 161.09)元对(86 903.23±2 051.69)元]。结论 LMA麻醉是房颤射频消融中可行的气道管理方法, 血流动力学稳定, 手术时间短, 术后并发症发生率低, 费用低。LMA麻醉是射频消融治疗房颤的理想麻醉方式。
Objective To compare the clinical efficacy and cost of the endotracheal tube(ETT)and the laryngeal mask airway(LMA)in radiofrequency ablation of atrial fibrillation(AF).Methods This study was a single-center cohort study.Patients with AF who underwent the first radiofrequency ablation of atrial fibrillation(RFCA)treatment in Beijing Chaoyang Hospital from July 2022 to December 2022 were enrolled.Airway management was achieved by LMA or ETT during RFCA.The intraoperative hemodynamics,anesthesia time,ablation time,postoperative complications,other clinical effects and costs were compared between the two groups.Results A total of 120 patients were enrolled in this study,including 82 males and 38 females,average age(65.0±1.2)years.The LMA group(n=60)had more stable hemodynamics and applied lower doses of norepinephrine(0.035±0.006)μg·kg^(-1)·min^(-1) vs.(0.003±0.004)μg·kg^(-1)·min^(-1),P<0.001).Operativetime[(143.00±4.46)min vs.(158.00±5.51)min,P=0.035],anesthesia time[(158.83±4.91)min vs.(183.67±5.98)min,P=0.002],ablation time[(1442.70±87.97)s vs.(1866.06±75.40)s,P<0.001],consciousness recovery time[(16.96±0.37)min vs.(5.53±0.27)min,P<0.001]and anesthesia recovery time[(33.03±0.55)min vs.(14.70±0.47)min,P<0.001]were shorter in with LMA group.The LMA group also had less postoperative sore throat(3%vs.40%;P<0.001),hoarseness(3%vs.30%;P<0.001)and nausea(6%vs.43%,P<0.001).The doses of propofol(26.67±1.37)mg vs.(19.86±0.81)mg,P<0.001 and remifentanil[(20.36±1.28)mg vs.(17.06±0.96)mg,P=0.044]were higher in ETT group.ETT group was associated with a small,12%increase(98912.04±1161.09)yuan vs.(86903.23±2051.69)yuan]in total charges due to high cost of equipment and longer anesthesia care.Conclusion LMA is a feasible option for airway management in radiofrequency ablation of atrial fibrillation,with stable hemodynamics,lower operation time,incidence of postoperative complications and cost.These characteristics make LMA a desirable conduit for radiofrequency ablation of atrial fibrillation.
作者
齐丹
张晓霞
关晓楠
马宁
刘丽凤
刘铮
刘小青
张建军
Qi Dan;Zhang Xiaoxia;Guan Xiaonan;Ma Ning;Liu Lifeng;Liu Zheng;Liu Xiaoqing;Zhang Jianjun(Department of Cardiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100040,China;Department of Anesthesiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100040,China)
出处
《中华心律失常学杂志》
2023年第6期542-547,共6页
Chinese Journal of Cardiac Arrhythmias
关键词
心房颤动
气管插管
喉罩
射频消融
费用
Atrial Fibrillation
Endotracheal tube
Laryngeal mask airway
Radiofrequency ablation
Cose
