经导管主动脉瓣置换术用局部麻醉和全身麻醉对患者安全性与有效性的Meta分析

The safety and efficacy of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement:a Meta-analysis

目的:系统评价经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)用局部麻醉与全身麻醉对患者的安全性与有效性。方法:检索自建库以来至2022年8月,PubMed、Embase、Cochrane图书馆、中国知网、万方数据库中的研究,同时采用Revman5.4、Stata12.0软件对纳入文献进行荟萃分析。结果:纳入23项研究共17177例,其中局部麻醉患者5303例,全身麻醉患者11874例,Meta分析结果显示,局部麻醉组与全身麻醉组相比急性肾损伤(OR=0.93,95%CI:0.65~1.33,P=0.69)差异无统计学意义;30d内死亡率(OR=0.84,95%CI:0.70~1.00,P=0.04)、卒中(OR=0.35,95%CI:0.14~0.98,P=0.03)、血管并发症(OR=0.47,95%CI:0.32~0.70,P=0.0002)、大出血事件(OR=0.54,95%CI:0.31~0.96,P=0.04)、手术时间(SMD=-0.74,95%CI:-0.96~-0.52,P<0.00001)、X光透视时间(SMD=-0.88,95%CI:-1.53~-0.23,P=0.008)、重症科住院时间(SMD=-0.37,95%CI:-0.66~-0.08,P=0.01)、住院总时间(SMD=-0.64,95%CI:-0.99~-0.28,P=0.0004)差异有统计学意义。结论:主动脉瓣狭窄患者在局部麻醉下进行TAVR治疗是可行、有效的,两组的急性肾损伤发生率差异无统计学意义。

Objective:To systematically evaluate the safety and efficacy of transcatheter aortic valve replacement(TAVR)with local versus general anesthesia for patients.Methods:Studies in PubMed,Embase,Cochrane Library,China Knowledge Network,and Wanfang database were searched since the establishment of the database until August 2022,and the included literature was also meta-analyzed using Revman 5.4 and Stata 12.0 software.Results:A total of 17177 cases were included in 23 studies,including 5303 patients under local anesthesia and 11874 patients under general anesthesia.Meta-analysis showed that the difference in acute kidney injury(OR=0.93,95%CI:0.65-1.33,P=0.69)was not statistically significant in the local anesthesia group compared with the general anesthesia group;mortality within 30 days(OR=0.84,95%CI:0.701.00,P=0.04),stroke(OR=0.35,95%CI:0.14-0.98,P=0.03),vascular complications(OR=0.47,95%CI:0.32-0.70,P=0.0002),major bleeding events(OR=0.54,95%CI:0.31-0.96,P=0.04),operative time(SMD=-0.74,95%CI:-0.96--0.52,P<0.00001),radiographic fluoroscopy time(SMD=-0.88,95%CI:-1.53--0.23,P=0.008),intensive care unit length of stay(SMD=-0.37,95%CI:-0.66--0.08,P=0.01)and total length of stay(SMD=-0.64,95%CI:-0.99--0.28,P=0.0004)were statistically significant.Conclusions:TAVR under local anesthesia is feasible and effective in patients with aortic stenosis,and there was no statistical difference in the incidence of acute kidney injury between the two groups.Compared with general anesthesia,patients under local anesthesia had lower rates of mortality,stroke,and vascular complications within 30 days,and shorter operative time,radiographic fluoroscopy time,intensive care unit length of stay,and total hospital stay.