镇静和全身麻醉用于经导管主动脉瓣置换术的效果对比

Comparison of Sedation and General Anesthesia in Transcatheter Aortic Valve Replacement

目的回顾性分析阜外医院经股动脉入路行经导管主动脉瓣置换术的患者资料,比较镇静和全身麻醉用于该手术的不同效果。方法通过分析该院2017年1月至2019年8月经股动脉入路行经导管主动脉瓣置换术的患者资料,按不同麻醉方式将患者分为镇静组(SED组)和全身麻醉组(GA组),比较两组患者的不同结局。结果共入选患者286例,SED组128例,GA组158例。与GA组患者相比,SED组患者去甲肾上腺素的使用率明显降低(4.69%,15.82%,P=0.003),手术时间[(1.99±0.80)h,(2.29±1.37)h,P=0.024]及ICU停留时间[0(0,1)d,1(0,2)d,P<0.001]均明显缩短,且总住院费用明显降低[31.5(7.9,33.8)万元,33.8(15.7,36.2)万元,P<0.001]。结论对于经股动脉入路行经导管主动脉瓣置换术的患者,镇静和全身麻醉均可成功使用。随着经验的不断积累,推荐对合适的患者选择镇静方式。

Objective To compare the outcomes of sedation(SED)and general anesthesia(GA)in transfemoral transcatheter aortic valve replacement(TF-TAVR)in Fuwai Hospital retrospectively.Methods Data of patients undergoing TF-TAVR from January 2017 to August 2019 at Fuwai Hospital were analyzed retrospectively.Patients were divided into two groups based on whether they received SED or GA.Results A total of 286 patients were enrolled,128 in the SED group and 158 in the GA group.Compared with patients in the GA group,the use of norepinephrine in the SED group decreased significantly during the procedure(4.69%vs 15.82%,P=0.003).The total procedural time[(1.99±0.80)h vs(2.29±1.37)h,P=0.024]and intensive care unit stay length[0(0,1)d vs 1(0,2)d,P<0.001]were significantly shorter,and the total hospitalization costs were reduced significantly[31.5(7.9,33.8)ten thousand yuan vs 33.8(15.7,36.2)ten thousand yuan,P<0.001]in the SED group.Conclusion The current study suggests that TF-TAVR can be done under either sedation or GA successfully.With the accumulation of experience,it is recommended to choose the sedation method to perform TF-TAVR in selected patients.