目的 总结心尖入路经导管主动脉瓣置换术(transapical transcatheter aortic valve replacement，TA-TAVR)的麻醉管理经验。方法 回顾性分析2023年1月～2024年1月我院心血管外科行TA-TAVR 60例的临床资料，包括主动脉瓣狭窄34例，主动脉瓣关闭不全26例。纽约心脏协会(New York Heart Association，NYHA)心功能分级Ⅱ级4例，Ⅲ级11例，Ⅳ级45例。美国麻醉医师协会(American Society of Anesthesiologists，ASA)分级Ⅱ级12例，Ⅲ级44例，Ⅳ级2例，V级2例。欧洲心脏手术风险评估系统Ⅱ(EuroSCORE Ⅱ)评分8。3％～54。1％，(20。0±10。3)％。均采用气管插管全身麻醉。结果 术中心室颤动3例。60例术后机械通气时间中位数17(0～192)h，其中0 h(手术室内拔管，即超快通道麻醉)5例，术后6 h内拔管(快通道麻醉)17例，6～48 h拔管31例，7例机械通气时间＞48 h。8例术后需要补救镇痛。ICU停留时间21(3～407)h，术后住院时间(7。8±4。5)d。术后并发症包括1例人工主动脉瓣瓣膜脱落急诊开胸手术，3例Ⅲ度房室传导阻滞永久起搏器植入，2例低氧血症再次气管插管。结论 优化麻醉干预措施(麻醉细节、麻醉监测手段、麻醉镇痛方案)，有助于早期拔管，实现TA-TAVR超快通道和快通道麻醉。
Anesthesia Management of Transapical Transcatheter Aortic Valve Replacement
Objective To summarize the experience of anesthesia management of transapical transcatheter aortic valve replacement(TA-TAVR).Methods Clinical data of 60 cases of TA-TAVR in the Cardiovascular Surgery Department of our hospital from January 2023 to January 2024 were retrospectively analyzed,including 34 cases of aortic stenosis and 26 cases of aortic insufficiency.According to the New York Heart Association(NYHA)functional classification,there were 4 cases of class Ⅱ,11 cases of class Ⅲ,and 45 cases of class Ⅳ.According to the American Society of Anesthesiologists(ASA)classification,there were 12 cases of grade Ⅱ,44 cases of grade Ⅲ,2 cases of grade Ⅳ,and 2 cases of grade V.The European System for Cardiac Operative Risk Evaluation Ⅱ(EuroSCORE Ⅱ)score was 8.3％-54.1％[mean,(20.0±10.3)％].All the patients received general anesthesia with endotracheal intubation.Results Intraoperative ventricular fibrillation occurred in 3 cases.The median mechanical ventilation time of the 60 patients was 17 h(range,0-192 h),including 5 cases of 0 h(extubation in the operating room,which was ultra-fast track anesthesia),17 cases of extubation within 6 h after surgery(fast track anesthesia),31 cases of extubation between 6 and 48 h,and 7 cases of mechanical ventilation time＞48 h.Rescue analgesia after surgery was required in 8 cases.The median ICU stay time was 21 h(range,3-407 h),and the postoperative hospital stay was(7.8±4.5)d.Postoperative complications included 1 case of emergency thoracotomy because of artificial aortic valve dislocation,3 cases of permanent pacemaker implantation because of third-degree atrioventricular block,and 2 cases of tracheal intubation again because of hypoxemia.Conclusion Optimizing the anesthesia intervention measures(anesthesia details,anesthesia monitoring methods,and anesthesia analgesia plan)is helpful for early extubation,achieving ultra-fast track and fast track anesthesia of TA-TAVR.
万方数据
维普
