【罂粟摘要】经股动脉导管主动脉瓣置入术中全身麻醉 与非全身麻醉的比较
经股动脉导管主动脉瓣置入术中全身麻醉
与非全身麻醉的比较
在非全身麻醉(GA)的情况下，经股动脉行主动脉瓣置入术(TAVI)已越来越多地被采用。我们试图研究全身麻醉与非全身麻醉在实施经股动脉入路行动脉瓣置入术中，对手术结果以及30天和1年死亡率的影响。
英国TAVI登记处保存着英国每个TAVI手术的信息。我们分析了2013-2014年间使用爱德华兹sapien或Medtronic心脏瓣膜假体植入患者的数据。进行倾向评分匹配分析以调整混杂因素。
共研究2243例患者(年龄81.4±7.5岁，男性1195例)。1816例(81%)接受了全身麻醉的TAVI，427例(19%)接受了非全身麻醉的TAVI。经食道超声心动图(TOE)在全身麻醉组和非全身麻醉组分别为92.3%和12.4%(P<0.001)。两组瓣膜展开成功率(全身麻醉组 97.2%vs非全身麻醉组95.7%，p=0.104)和术后轻度 以上主动脉瓣反流(AR)发生率(全身麻醉组5.6%vs非全身麻醉组7.0%，p=0.295)无显著差异。而全身麻醉组手术时间较长(131±60vs121±60min，p=0.002)，住院时间较长(8.0士13.5vs5.7±5.5d，p<0.001)。
全身麻醉组和非全身麻醉组病例的30天和1年死亡率没有差异。在倾向匹配之后，这些结果保持不变。第二个倾向性分析(根据麻醉方式进行了调整)没有显示使用经食道超声心动图与瓣膜成功置换率或信号之间的关联，另使用经食道超声心动图与更长的手术时间或更长的住院时间仍然无关。
麻醉方式不影响手术结果、30天和1年死亡率。然而，全身麻醉与更长的程序持续时间和更长的住院时间相关。
Comparison of general anaesthesia and non-general anaesthesia approach in transfemoral transcatheter aortic valve implantation
Abstract
Objective Performing transfemoral transcatheter aortic valve implantation (TAVI) without general anaesthesia(ga) has been increasingly adopted. We sought to study the impact of ganeral and non-ganeral approaches on procedural outcome and 30-day and 1-year mortality in transfemoral TAVI.
Methods the UK TAVI registry holds information for every TAVI procedure in the UK. We analysed the data for patients implanted during 2013–2014 using either an edwards sapien or a Medtronic coreValve prosthesis. Propensity score-matching analysis was performed to adjust for confounding factors.
Results 2243 patients were studied (aged 81.4±7.5years, 1195 males). 1816 (81%) underwent TAVI with ga and 427 (19%) without ga. Transoesophageal echocardiography (TOE) was used in 92.3% of ga and 12.4% of non-ga cases (p<0.001). there was no signifcant difference in the rate of successful valve deployment (ga 97.2% vs non-ga 95.7%, p=0.104) and in the incidence of more than mild aortic regurgitation (ar) at the end of the procedure (ga 5.6% vs non-ga 7.0%, p=0.295). however, procedure time was longer (131±60 vs 121±60mins, p=0.002) and length of stay was greater (8.0±13.5 vs 5.7±5.5 days, p<0.001) for ga cases. 30-day and 1-year mortality rates did not differ between the ga and non-ga cases. After propensity matching, these results remained unchanged. a second propensity analysis (adjusted for mode of anaesthesia) did not show an association between use of TOE and rate of successful valve deployment or frequency of signifcant ar. neither was TOE associated with a longer procedural time or greater length of stay.
Conclusion Procedure outcome, and 30-day and 1-year mortality are not influenced by mode of anaesthesia. however, ga is associated with longer procedure duration and greater length of stay.
翻译：安丽
编辑：佟睿
审核：曹莹