超声引导下高位髂筋膜阻滞在经导管主动脉瓣置换术中的应用

Application of ultrasound-guided high iliac fascial block in transcatheter aortic valve replacement

中文关键词: 超声  高位髂筋膜阻滞  经导管主动脉置换术

英文关键词: Ultrasound  High iliac fascia block  Transcatheter aortic valve replacement

中文摘要:

      
目的 探索超声引导下高位髂筋膜阻滞用于经导管主动脉置换术的效果。
方法 收集2016年12月至2020年12月监测麻醉下行经导管主动脉置换术患者资料126例，男85例，女41例，年龄65～90岁，BMI 22～25 kg/m²，ASA Ⅲ或Ⅳ，术前诊断为主动脉瓣重度狭窄，NYHA Ⅲ或Ⅳ级且首次经历心脏手术。按照术中是否进行高位髂筋膜阻滞分为两组：对照组（C组，n=56）和联合组（T组，n=70）。C组仅采用监测麻醉，T组采用监测麻醉联合高位髂筋膜阻滞。采用卡钳法进行倾向值匹配。收集并记录性别、年龄、BMI、ASA分级、主动脉瓣口面积、主动脉瓣平均跨瓣压、合并症（冠心病、高血压、糖尿病）。记录手术时间、术中丙泊酚和舒芬太尼用量、术后补救镇痛情况、苏醒时间、ICU停留时间、术后住院时间、术后30 d死亡例数。记录术中呼吸抑制、术后恶心呕吐、谵妄/脑卒中的发生情况。
结果 44对患者资料匹配成功。匹配后,与C组比较，T组术中丙泊酚和舒芬太尼用量明显减少（P<0.05），术后补救镇痛率明显降低（P<0.05），术后苏醒时间、ICU停留时间和术后住院时间明显缩短（P<0.05），术中呼吸抑制发生率和术后恶心呕吐发生率明显降低（P<0.05）。两组其余指标差异均无统计学意义。
结论 超声引导下高位髂筋膜阻滞用于经导管主动脉置换术可减少术中麻醉药物用量，缩短苏醒时间和ICU停留时间，减少术后补救镇痛和不良反应的发生，有助于早期康复。

英文摘要:

      
Objective To expore the efficacy of ultrasound-guided high iliac fascial block in transcatheter aortic replacement.
Methods A total of 126 patients with transcatheter aorta valve replacement surgery under monitored anesthesia care were selected from December 2016 to December 2020, 85 males and 41 females, aged 65-90 years, BMI 22-25 kg/m², ASA physical status Ⅲ or Ⅳ, preoperative diagnosis of severe stenosis of the aortic valve, New York cardiac function grade Ⅲ or Ⅳ. According to whether high iliac fascia block was performed during surgery, patients were divided into two groups: the control group (group C, n = 56) and the composite group (group T, n = 70). Monitored anethesia care was applied only in group C, and group T used monitored anethesia care compound high iliac fascial block. Propensity value matching was performed by caliper method. Sex, age, BMI, ASA physical status, aortic valve orifice area, aortic valve mean transvalvular pressure, comorbidities (coronary heart disease, hypertension, diabetes mellitus) were recorded. The operation time, intraoperative anesthesia sedative/analgesic drug dosage, postoperative remedial analgesia rate, wake-up time, ICU residence time,hospitliztion time, and postoperative 30-day mortality, incidence of intraoperative respiratory depression, incidence of postoperative nausea/vomiting, incidence of delirium/stroke, complications of iliac fascial block were recorded.
Results Forty-four pairs of patient data were successfully matched. Compared with group C, the dosage of intraoperative anesthetic sedative and analgesic drugs and postoperative remedial analgesia rate in group T were significantly reduced (P < 0.05), postoperative recovery time, ICU residence time, and hospitliztion time, were significantly shortened (P < 0.05), and the incidence of postoperative respiratory depression and postoperative nausea and vomiting were significantly reduced (P < 0.05). There were no significant differences in other indexes between the two groups.
Conclusion Ultrasound-guided high iliac fascial block in transcatheter aortic valve replacement can reduce the amount of anesthetic drugs, shorten the time of wake up and stay in ICU, reduce the occurrence of postoperative analgesia and adverse reactions, and be beneficial to the early recovery of patients.