摘要: |
目的:分析经心尖置入国产生物支架主动脉瓣的麻醉管理方案及预后。方法:选择进行经心尖主动脉瓣置入术的11例患者(平均年龄77.91岁),其中主动脉瓣狭窄7例、关闭不全4例。术前即开始水化治疗,采用严格的麻醉设计和仔细的血流动力学管理方法。麻醉诱导后经左侧颈内静脉放置临时起搏器,记录术前、术中、术后血流动力学参数,记录手术时间、气管导管拔管时间、监护室停留天数、住院天数,以及并发症和全因死亡情况。结果:11例患者中,9例顺利完成手术。术后1周,1例患者发生肝肾功能不全;2例患者发生低氧,其中1例死亡。所有术中和术后并发症均发生于主动脉瓣狭窄患者。诱导后患者的血压和心率(heart rate,HR)、心排量(cardiac output, CO)、心排血指数(cardiac index,CI )均明显降低,并持续到瓣膜释放后(P<0.05)。至手术结束时,CO和HR降至诱导前水平;平均动脉压(mean arterial pressure, MAP)和CI依然低于诱导前水平,但波动均在可接受的范围,且未导致明显的不良预后。结论:经心尖主动脉瓣置入术需要严格的麻醉设计及仔细的血流动力学管理来有效保障患者安全度过手术期;瓣膜狭窄患者可能较关闭不全患者有更复杂的手术过程及相对危险的预后。 |
关键词: 经心尖主动脉瓣置入术 全身麻醉 围手术期管理 |
DOI:10.12025/j.issn.1008-6358.2017.20160293 |
分类号: |
基金项目: |
|
|
|
|
Abstract: |
Objective:To analyze the anesthetic managements during trans apical aortic valve implantation and the prognosis of patients. Methods:Totally 11 cases undergoing TA TAVI was enrolled (the average age was 77.91), including 7 cases of aortic stenosis and 4 cases of aortic regurgitation. Hydration treatment was started preoperatively, and strict anesthetic design and careful hemodynamic managements were adopted. After induction the temporary pacemaker wire was placed via the internal jugular vein. The hemodynamic parameters, extubation time, length of ICU stay and hospitalization days, complications and all cause mortality before surgery, during surgery and after surgery was recorded and analyzed. Results:The 9 out of 11 patients experienced successful valve implantation procedure, 1 patient suffered hepatic and renal dysfunction in 1 week after surgery, and 2 patients suffered hypoxemia, and one of the two died at last. All the complications occurred in patients with aortic stenosis. Compared with baseline, the patients’ blood pressure, heart rate (HR), cardiac output (CO), and cardiac index (CI) after induction were significantly reduced until the valve opened (P<0.05). To the end of the surgery, CO and HR reduced below the basic level, and mean arterial pressure (MAP) and CI were still below the basic level. But the hemodynamics fluctuated in an acceptable range, and did not result in any adverse consequences. Conclusions:Even if the anesthesia of TA TAVI is challenging, strict anesthetic design and careful hemodynamic management can ensure the safety of patients. Also the patients with aortic valve stenosis suffered more complicated surgical procedure and unfavorable prognosis. |
Key words: transcatheter aortic valve implantation general anesthesia perioperative management |