心房颤动射频导管消融术中的镇静和麻醉措施分析：系统综述

Anesthesia and sedation management of radiofrequency catheter ablation for atrial fibrillation： a sys- tematic review

目的射频导管消融已成为心房颤动（房颤）的一线疗法，由于存在较强程度的疼痛，因而需要清醒镇静（conscious sedation）、深度镇静（deep sedation）、全身麻醉（general anesthesia）等不同措施辅助射频导管消融治疗的顺利进行。本研究旨在对不同镇静和麻醉方式对射频导管消融操作、成功率、并发症等方面的影响进行系统评价。方法检索MEDLINE、Cochrane图书馆、EMBASE数据库，纳入2000年1月至2013年12月期间发表的4项比较不同镇静或麻醉模式对射频导管消融治疗影响的随机对照研究进行系统分析。结果4项随机对照研究不均一性高，不能提取数据进行荟萃分析。系统综述结果如下：①清醒镇静、深度镇静、全身麻醉对操作时间和放射暴露时间的影响存在诱导偏倚，结论存在争议；②不同麻醉管理方式对肺静脉隔离成功率影响差异无统计学意义，全身麻醉管理下房颤复发率较清醒镇静低（P〈0．001），肺静脉电位再连接率低（P=0．003）；③清醒镇静组患者低血压、低血氧饱和度发生率低（P〈0．001，P〈0．001），食管损伤相关并发症风险小（P〈0．001）；④清醒镇静可满足镇静、镇痛需求，与深度镇静相比术者行射频导管消融操作满意率高（P=0．002）。结论镇静和麻醉均可被用于房颤射频导管消融术，且各具优劣。

Objective As an effective treatment for atrial fibrillation, radiofrequeney catheter ablation can be performed under different anesthetic managements,including conscious sedation, deep sedation and gen- eral anesthesia. However, the effects of these three anesthetic managements on the radiofrequency therapy have not been systematically reviewed. This systematic review aimed at evaluating the effect of different anesthetic managements on ablation procedure, success rate and complication occurrence. Methods We systematically searched MEDLINE, Cochrane Library, and EMBASE databases for clinical trials published between January 2000 and December 2013, and 4 randomized controlled trials had been included. Results The significant high level of heterogeneity of the studies prohibited a meta-analysis. The main findings were： Controversial effects of different anesthetic managements on the procedural time and fluoroscopy time due to the induced bias. No statistical significance was recognized on the success rate of pulmonary vein isolation under different anesthetic strategies. The recurrence of atrial fibrillation and pulmonary vein reconnection rate in the general anesthesia group was significantly lower than that of the conscious sedation （ P〈0. 001 ）. Patients under conscious sedation experienced less possibility of hypotension （ P〈0. 001 ）, hypoxia （ P〈0. 001 ） and were less likely to suffer from esophageal injuries （P〈0. 001 ）. Compared with deep sedation ,the satisfactory rate of electrophysi- ologists was higher in conscious sedation group （P = 0. 002）. Conclusion Both conscious sedation and general anesthesia could be applied as anesthetic managements for the radiofrequency catheter ablation therapy of atrial fibrillation.