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不同麻醉方式与经股主动脉瓣置换术患者预后之间的关系
贵州医科大学 麻醉与心脏电生理课题组
翻译：文春雷 编辑：杨荣峰 审校：曹莹
越来越多的患者在麻醉镇静下接受经股主动脉瓣置换术（TAVR）。目前关于不同类型镇静药物的疗效和安全性的数据有限。本研究的目的是比较两种镇静技术在血管活性支持需求、呼吸支持、转换为全身麻醉（GA）的比例、常见围手术期并发症、重症监护病房（ICU）住院时间和院内死亡率方面的差异。
本研究为回顾性病例分析，研究对象为2016年1月至2019年12月在一家专科心脏中心接受TAVR的患者。数据收集包括患者诊断、术前合并症、术中结果和术后结果。
共289名患者接受了局部麻醉；210名接受了丙泊酚输注，79名接受了混合丙泊酚-氯胺酮输注（Ketofol）。平均年龄为75.5 ± 8.9岁，58.1%的患者为女性。比较丙泊酚组和Ketofol组，分别有31.2%和34.2%的患者需要药物支持，7.6%和6.3%需要转换为GA，46.7%和59.5%需要呼吸支持。这些术中结果在组间没有显著差异，P = 0.540，P = 0.707，P = 0.105。丙泊酚组和Ketofol组的院内30天死亡率分别为1.9%和3.8%，P = 0.396。在两个组中，术后冠脉监护病房的中位住院时间为26小时，而术后住院时间为3天。
在接受TAVR的患者中，使用丙泊酚或Ketofol的围手术期或术后结果没有显著差异。丙泊酚输注，无论单独使用还是与氯胺酮联合使用，都是可靠且安全的，副作用最小。
原始文献来源：Ahmad · Abuzaid/, Ibrahim · AbdelAal, Ahmed · Galal. The association between different anesthetic techniques and outcomes in patients undergoing transfemoral aortic valve replacement.[J]. Saudi J Anaesth, 2024, 18(2): 197-204.
The association between different anesthetic techniques and outcomes in patients undergoing transfemoral aortic valve replacement
Background: There is an increasing number of patients undergoing transfemoral aortic valve replacement (TAVR) with sedation. There is limited data assessing the efficacy and safety of the different types of sedative drugs. The objective was to compare two sedation techniques with regard to the need for vasoactive support, respiratory support, rate of conversion to general anesthesia (GA), common perioperative morbidities, intensive care unit (ICU) stay, and in-hospital mortality.
Methods: A retrospective chart review study conducted among patients who underwent TAVR at a specialized cardiac center between January 2016 and December 2019. Data collection included patient diagnosis, preoperative comorbidities, intraoperative outcomes, and postoperative outcomes.
Results: A total of 289 patients received local anesthesia; 210 received propofol infusion and 79 received a mixed propofol‑ketamine infusion (Ketofol). The average age was 75.5 ± 8.9 years and 58.1% of the patients were females. Comparing propofol and ketofol groups, 31.2% and 34.2% of the patients required drug support, 7.6% and 6.3% required conversion to GA, 46.7% and 59.5% required respiratory support, respectively. These intraoperative outcomes were not significantly different between groups, P = 0.540, P = 0.707, and P = 0.105, respectively. In‑hospital 30‑day mortality in propofol and ketofol groups were 1.9% and 3.8%, respectively, P = 0.396. In both groups, the median post-procedure coronary care unit stay was 26 hours while post‑procedure hospital stay was 3 days.
Conclusions: There were no significant differences in perioperative or postoperative outcomes in TAVR patients receiving either propofol or ketofol. Propofol infusion, either alone or with ketamine, is reliable and safe, with minimal side effects.
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