全身麻醉与局部麻醉在经导管主动脉瓣置换术中的安全性对比

Safety of local anesthesia versus general anesthesia in transfemoral transcatheter aortic valve replacement:Comparative study

目的比较局部麻醉与全身麻醉两种不同麻醉方式在主动脉瓣狭窄患者经导管主动脉瓣置换术的安全性。方法收集医院严重主动脉瓣狭窄需进行经股TAVR的病患98例并随机分成局部麻醉组(LA)及全身麻醉组(GA),分别实施局部麻醉与全身麻醉,并于手术后观察并记录患者手术后30 d死亡率,瓣膜旁反流,重症监护时间,中风,心源性休克,心脏压塞,大血管损伤,感染和急性肾损伤以及3年生存率等指标。结果 30 d死亡率结果显示,LA组(4.08%)与GA组(6.12%)差异无统计学意义(P>0.05);两种麻醉术均出现轻度的瓣膜旁反流(LA48.9%VS GA 57.0%,P>0.05),且在LA麻醉中患者中出现一例重度的瓣膜反流。重症监护时间结果显示,在LA组中,平均重症监护时间为2.9 d,GA组为3.5 d(P>0.05);此外,无中风,心源性休克,心脏压塞,大血管损伤,感染和急性肾损伤等并发症发生;而3年生存率结果显示,LA组为79.5%,GA组为81.6%(P>0.05)。结论 TAVR手术中采用LA与GA具有相似的短期与长期结果,然而,采用LA是否会出现更为严重的瓣膜反流需要进一步的调查。

Objective To evaluate outcomes of local anesthesia(LA)and compared with general anesthesia(GA)in patients undergoing transfemoral transcatheter aortic valve replacement(TAVR).Methods The98patients with severe and symptomatic aortic stenosis who were subject to LA or GA,and then transfemoral TAVR under LA or GA.After that,the30-day mortality,mean intensive care unit stay,paravalvular regurgitation,stroke,cardiogenic shock,cardiac tamponade,major vascular damage,infection,and emergence percutaneous coronary were observed and recorded.Besides,3-year survival rate was also recorded.Results LA was associated with similar30-day mortality compared with GA,and the risk of paravalvular regurgitation was similar between two groups.Other risk effects such as strock,major vascular damage etc were rarely happened.However,a severe paravalvular regurgitation was observed in LA group.Mean intensive care unit stay was2.9days in the LA group versus3.5days in the GA group.A similar3-year survival rate was observed(LA,79.5%,GA81.6%).Conclusion Transfemoral TAVR can be performed under LA with similar inmmediate and late outcomes as compared with GA.A possible risk of severe paravalvular regurgitation with TAVR under LA requires further investigation.