腹主动脉瘤腔内修复术不同麻醉方式的比较

Comparison of perioperative outcomes under different anesthetic methods for endovascular abdominal aortic aneurysm repair （EVAR）

目的总结在不同麻醉方式下行腹主动脉瘤腔内治疗（endovascular aneurysm repair，EVAR）的围手术期结果，为EVAR术选择麻醉方式提供参考。方法回顾性分析四川大学华西医院血管外科从2006年1月至2012年9月收治的择期接受EVAR术的276例腹主动脉瘤（abdominal aortic aneurysm，AAA）患者的临床资料，其中105例（38．0％）采用局部麻醉（local anesthesia，LA），56例（20．3％）采用硬膜外麻醉（epiduralanesthesia，EDA），115例（41．7％）采用全身麻醉（general anesthesia，GA），比较3组基线资料、动脉瘤数据资料、围术期相关资料。结果术中麻醉或手术方式无改变。LA组的肺部疾病患病率（71／105，67．6％）显著高于GA组（60／115，52．2％，P=0．020）。LA组较EDA及GA组显著缩短了手术持续时间、ICU观察时间、术后禁食时间及术后住院时间，其差异具有统计学意义。LA组术后肺部并发症发生率（1／105，1％）显著低于GA组（11／115，9．6％，P=0．005）。麻醉方式是术后并发症发生的独立危险因素，局部麻醉显著降低了术后发生并发症的风险。结论局部麻醉更有利于EVAR术后患者的恢复，局部麻醉可能成为EVAR优先选择的麻醉方式。

Objective To compare perioperative outcomes of endovascular abdominal aortic aneurysm repair （EVAR） by different methods of anesthesia. Method From January 2006 to September 2012, 276 abdominal aortic aneurysm （AAA） patients undergoing EVAR in West China Hospital were retrospectively analyzed. Among these patients, 105 cases （38.0%） received LA, 56 patients （20. 3% ） received EDA, 115 patients （41.7%） received GA. Data of perioperative outcome and AAA among three different anesthesia groups were collected. Result Conversion of anesthetic techniques was not required. Lung complication was significantly lower in the GA group （60/115,52. 2% ） than the LA group （71/105, 67.6%, P =0. 02）. Compared with EDA and GA groups, patients in LA group had significantly shorter operating time, time of ICU stay, time to ambulation and hospital stay. Logistic regression analysis indicated the anesthesia method was an independent related factor for postoperative complications and LA decreased morbidity of patients with EVAR. Conclusions Local anesthesia has the advantages of shorter operation time and lower incidence of complications.