3例经股动脉径路行导管主动脉瓣置入术的麻醉管理

Anesthetic management of transfemoral approach transcatheter aortic valve implantation under general anesthesia in 3 cases

目的探讨经股动脉径路行导管主动脉瓣置入术的麻醉管理经验。方法回顾性分析该院2017年10月3例经股动脉径路行导管主动脉瓣置入术患者的麻醉管理、术中监测及循环管理等。结果所有患者均进行气管插管全身麻醉,麻醉诱导平稳,术中给予血管活性药物,无严重的血流动力学紊乱。手术均采用股动脉径路,在球囊扩张及瓣膜置入过程中,患者血流动力学平稳,无严重麻醉不良事件。1例发生冠状动脉阻塞,抢救无效死亡,另外2例患者术后心功能明显改善,均正常出院。结论经导管主动脉瓣置入术可在气管插管全身麻醉下进行,充分的术前准备、完善的术中监测、严密的血流动力学管理与密切的多学科协作是手术成功的重要保障。

Objective To explore the experience of anesthetic management for transfemoral approach transcatheter aortic valve implantation（TAVI）under general anesthesia.Methods The anesthetic management,intraoperative monitoring,and circulatory management in 3 patients undergone transfemoral approach TAVI in this hospital during October 2017 were were analyzed retrospectively.Results All patients received general anesthesia with endotracheal intubation.Stable anesthesia induction was reached.Severe hemodynamics disturbance did not occurred with vasopressor support during operation.All the operations were performed through the transfemoral approach,hemodynamic stabilization was maintained during balloon dilation and aortic valve implantation,and there were no adverse events related to anesthesia.One case developed the coronary arterial blocking and died due to invalid rescue.The cardiac function in other 2 cases was significantly improved after operation and were normally discharged from hospital.Conclusion TAVI can be conducted under general anesthesia with endotracheal intubation.Sufficient preoperative preparation,perfect intraoperative monitoring,strict hemodynamic management and close multidisciplinary collaboration are the important factors of operation success.