在胸内血管大动脉修复期间使用脊柱麻醉
Benjamin D Gross1, Jerry Zhu1, Ajit Rao1
1Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY.
Annals of vascular surgery
|October 6, 2023
概括
脊柱麻醉 (SA) 在胸内移植修复方面提供比全身麻醉 (GA) 更好的结果,减少死亡率和停留时间. 将SA与脑脊液排水 (CSFD) 结合起来,进一步提高了患者的安全性和恢复.
科学领域:
- 心血管外科心血管外科
- 麻醉学 麻醉学
- 胸部外科手术 胸部外科手术
背景情况:
- 胸内移植的安置是一个复杂的程序,具有重大风险.
- 麻醉选择影响胸内移植修复后的患者结果.
- 大脑脊髓液排水 (CSFD) 有时被用来作为辅助.
研究的目的:
- 为了比较脊髓麻醉 (SA) 和胸内移植手术的全身麻醉 (GA) 之间的结果.
- 评估CSFD与SA或GA一起使用时的有效性.
主要方法:
- 对333名接受胸内移植 (2001-2019) 的患者进行了回顾性审查.
- 根据麻醉类型分层的患者:GA,SA,GA与CSFD,SA与CSFD.
- 分析结果:30天死亡率,停留时间 (LOS),并发症.
主要成果:
- 与GA相比,SA组的30天死亡率 (0%对5.6%),再干预和返回OR显著较低.
- SA与较短的LOS (4.29 vs. 9.70天) 和较低的脊髓缺血发病率相关.
- 患有CSFD的SA没有显示脊髓缺血和较少的外科手术后并发症 (0%vs33.3%).
结论:
- 对于接受胸内移植修复的高风险患者来说,SA是一种可行的GA替代品.
- SA显示死亡率降低,神经系统并发症和LOS.
- 与CSFD结合的SA产生了有利的结果,与与CSFD结合的GA相比.
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