在监控麻醉治疗下进行过导管大动脉置换期间的高头:一项回顾性队列研究
Tzonghuei Chen1, Shyamal Asher2, Patricia Apruzzese2
1Department of Anesthesiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA herbchen@gmail.com.
Open heart
|August 30, 2024
概括
透气管大动脉置换 (TAVR) 与深度镇静经常导致显著的高头. 虽然没有影响结果,但这种高头症增加了对血液动力学和呼吸系统支持的需求.
科学领域:
- 心脏病学 心脏病学
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
背景情况:
- 在监控麻醉治疗 (MAC) 期间,急性手术内超和呼吸系统酸症对经过过导管大动脉置换 (TAVR) 的大动脉狭窄患者构成心肺风险.
- 了解手术期间MAC转移性TAVR的发生率,风险因素和影响对于患者的安全至关重要.
研究的目的:
- 评估在接受 transfemoral TAVR.患者的监控麻醉护理 (MAC) 期间手术内超的发生率.
- 在这个患者群体中识别与手术内头皮增大相关的危险因素.
- 为了评估手术内超头症对术后结果的影响.
主要方法:
- 对201名连续接受MAC (propofol和dexmedetomidine) 输血性TAVR的患者进行了回顾性分析.
- 在手术期间采集的动脉血液气体 (pH,PaCO2,PaO2) 数据在基线,门前部署和麻醉后护理单位到达时收集.
- 使用费舍尔精确测试,t测试,威尔科克森等级和线性回归来确定与人口统计,麻醉剂和血管活性药物数据的关联以及术后结果的统计分析.
主要成果:
- 超 (PaCO2增加28.4%) 在91%的患者中发生.
- 年龄较小,男性性别,体重增加和更高的普罗波剂量与增加的PaCO2和高头有关.
- 严重的头皮增大 (PaCO2>60 mmHg,pH ≤7.2) 与增加对血管活性药物的需求相关,但没有不良的术后结果.
结论:
- 在深度镇静 (propofol/dexmedetomidine) 的肺输血TAVR期间,过渡性显著的高头是常见的.
- 虽然术后结果没有显著影响,但高头症增加了对血管压缩剂和异型药物的需求.
- 在TAVR使用深度镇静时,预测高头和需要血液动力学/呼吸支持是必不可少的.
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