Circulation:经导管主动脉瓣置换术患者:全麻与清醒镇静哪个更安全有效?

2018-01-19 闫盈盈 环球医学

发表在《Circulation》上的一项研究,在进行经导管主动脉瓣置换术(TAVR)的患者当中,对TAVR期间使用清醒镇静的有效性和安全性进行了考察。

发表在《Circulation》上的一项研究,在进行经导管主动脉瓣置换术(TAVR)的患者当中,对TAVR期间使用清醒镇静的有效性和安全性进行了考察。

背景:在实践中,TAVR期间使用清醒镇静的有效性和安全性的证据是有限的。

方法:采用全国心血管数据注册登记的胸外科学会/美国心脏病学会经导管瓣膜治疗注册研究数据,对于在2014年4月1日~2015年6月30日期间进行择期经皮股动脉TAVR的所有美国患者,描述其麻醉方法选择和临床结局。采用原始和治疗加权逆概率分析,比较使用全麻vs清醒镇静进行TAVR患者在意向性治疗基础上的首要结局(院内死亡率)和次要结局(30天死亡率、院内及30天死亡/卒中、操作成功、重症监护单元和住院时间、出院回家率)。并对评估残余混杂因素进行了事后证伪终点分析。

结果:1737/10997例(15.8%)患者使用清醒镇静,且随着研究时间的延长,具有数量增加的显着趋势(P<0.001)。原始分析中,清醒镇静和全麻的手术成功率相似(98.2% vs 98.5%;P=0.31)。清醒镇静组,院内(1.6% vs 2.5%;P=0.03)及30天死亡(2.9% vs 4.1%;P=0.03)的可能性更低。1737例清醒镇静的患者中,有102例(5.9%)由清醒镇静转换为全麻。对51个协变量进行治疗加权逆概率调整后,清醒镇静与较低的手术成功率(97.9% vs 98.6%;P<0.001)和院内(1.5% vs 2.4%;P<0.001)及30天时间点的死亡率(2.3% vs 4.0%;P<0.001)降低相关。清醒镇静与术中正性肌力药物的需求、重症监护单元和住院时间(6.0 vs 6.5天;P<0.001)、30天死亡/卒中复合率(4.8% vs 6.4%;P<0.001)的降低相关。血管并发症、出血、新型起搏器/除颤器植入术的事后证伪终点分析证实,调整后组间无显着性差异。

结论:在美国临床实践中,未调整和调整分析显示,在进行TAVR的患者中,与全麻相比,清醒镇静与更少的住院时间和院内及30天时间点的死亡率降低相关。尽管使用观察性数据的有效性比较分析不能明确建立一种技术比另一种技术的优越性,但这些结果表明了清醒镇静在TAVR的患者人群中的安全性。

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    2018-04-15 yxch48
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  5. 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  6. 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  7. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510119, encodeId=c30e1510119c2, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Sun Jan 21 03:04:00 CST 2018, time=2018-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1536523, encodeId=d9e61536523d8, content=<a href='/topic/show?id=a894e826546' target=_blank style='color:#2F92EE;'>#经导管主动脉瓣置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78265, encryptionId=a894e826546, topicName=经导管主动脉瓣置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b38112697961, createdName=yytms, createdTime=Sun Jan 21 03:04:00 CST 2018, time=2018-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576595, encodeId=8ff315e65955a, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Sun Jan 21 03:04:00 CST 2018, time=2018-01-21, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1805464, encodeId=a4fd18054649f, content=<a href='/topic/show?id=e2c0e826827' target=_blank style='color:#2F92EE;'>#经导管主动脉瓣置换术患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78268, encryptionId=e2c0e826827, topicName=经导管主动脉瓣置换术患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec37461, createdName=szhvet, createdTime=Fri Mar 30 04:04:00 CST 2018, time=2018-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742463, encodeId=4dc91e424634a, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Sun Apr 15 08:04:00 CST 2018, time=2018-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1973372, encodeId=c9fb19e337265, content=<a href='/topic/show?id=5ca766263ad' target=_blank style='color:#2F92EE;'>#清醒镇静#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66263, encryptionId=5ca766263ad, topicName=清醒镇静)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/6F20312C71B4B22F603078C6DCFA72CE/100, createdBy=d3572500071, createdName=ms306040998833292, createdTime=Wed Jun 27 23:04:00 CST 2018, time=2018-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332492, encodeId=44c113324925a, content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, objectType=article, channel=null, 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510119, encodeId=c30e1510119c2, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Sun Jan 21 03:04:00 CST 2018, time=2018-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1536523, encodeId=d9e61536523d8, content=<a href='/topic/show?id=a894e826546' target=_blank style='color:#2F92EE;'>#经导管主动脉瓣置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78265, encryptionId=a894e826546, topicName=经导管主动脉瓣置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b38112697961, createdName=yytms, createdTime=Sun Jan 21 03:04:00 CST 2018, time=2018-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576595, encodeId=8ff315e65955a, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Sun Jan 21 03:04:00 CST 2018, time=2018-01-21, status=1, ipAttribution=)]
    2018-01-21 lsj631
  9. 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  10. 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