清醒镇静与全身麻醉对房颤导管射频消融手术影响的比较
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摘要
为比较清醒镇静和全身麻醉方案对房颤导管射频消融术的影响,回顾性分析笔者所在医院2013年6月～2016年6月房颤导管射频消融手术病历561例(清醒镇静237例,全身麻醉324例)。对两组手术时间、消融时间、透视时间、消融即刻成功率、住院时间、并发症、术后复发率进行比较。结果显示全麻组手术时间、消融时间、全麻组术后恶心、呕吐的发生率低于镇静组(P<0.01)。两组透视时间、术后即刻成功率、住院天数、呼吸道感染及心包填塞等并发症发生率相似(P>0.05)。术后12个月内两组患者房颤总体复发率及两组内持续性房颤复发率无统计学差异(P>0.05)。全麻组阵发性房颤患者术后12个月内复发率低于镇静组(P<0.05)。因此,全身麻醉和清醒镇静均可安全应用于房颤导管射频消融手术。全身麻醉方案可缩短手术时间和消融时间并可降低阵发性房颤患者术后12个月内房颤复发率。5-HT3受体拮抗剂能降低患者全麻房颤射频消融术后恶心呕吐的发生率。
To investigate the effects of conscious sedation and general anesthesia on radiofrequency catheter ablation of atrial fibrillation.A retrospective analysis of 561 cases(237 cases of conscious sedation and 324 cases of general anesthesia)of atrial fibrillation catheter radiofrequency ablation from June 2013 to June 2016.The authors collect and compare the time of surgery,ablation time,fluoroscopy time,immediate success rate of ablation,length of hospital stay,complications,and postoperative recurrence rate.The results showed that the incidence of nausea and vomiting in general anesthesia group was lower than that in sedation group(P<0.01).The fluoroscopy time,immediate success rate,hospital stay,respiratory tract infection and pericardial tamponade were similar between the two groups(P>0.05).There was no significant difference in the overall recurrence rate of atrial fibrillation and the recurrence rate of persistent atrial fibrillation between the two groups within 12 months after operation(P>0.05).The recurrence rate of patients with paroxysmal atrial fibrillation in the general anesthesia group was lower than that in the sedation group within 12 months after operation(P<0.05).Therefore,general anesthesia and conscious sedation can be safely applied to radiofrequency catheter ablation of atrial fibrillation.General anesthesia can shorten the operation time and ablation time and reduce the recurrence rate of atrial fibrillation within 12 months after operation in patients with paroxysmal atrial fibrillation.5-HT3 receptor antagonist can reduce the incidence of nausea and vomiting after radiofrequency ablation in patients with atrial fibrillation.
To investigate the effects of conscious sedation and general anesthesia on radiofrequency catheter ablation of atrial fibrillation.A retrospective analysis of 561 cases(237 cases of conscious sedation and 324 cases of general anesthesia)of atrial fibrillation catheter radiofrequency ablation from June 2013 to June 2016.The authors collect and compare the time of surgery,ablation time,fluoroscopy time,immediate success rate of ablation,length of hospital stay,complications,and postoperative recurrence rate.The results showed that the incidence of nausea and vomiting in general anesthesia group was lower than that in sedation group(P<0.01).The fluoroscopy time,immediate success rate,hospital stay,respiratory tract infection and pericardial tamponade were similar between the two groups(P>0.05).There was no significant difference in the overall recurrence rate of atrial fibrillation and the recurrence rate of persistent atrial fibrillation between the two groups within 12 months after operation(P>0.05).The recurrence rate of patients with paroxysmal atrial fibrillation in the general anesthesia group was lower than that in the sedation group within 12 months after operation(P<0.05).Therefore,general anesthesia and conscious sedation can be safely applied to radiofrequency catheter ablation of atrial fibrillation.General anesthesia can shorten the operation time and ablation time and reduce the recurrence rate of atrial fibrillation within 12 months after operation in patients with paroxysmal atrial fibrillation.5-HT3 receptor antagonist can reduce the incidence of nausea and vomiting after radiofrequency ablation in patients with atrial fibrillation.
引文
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[14]NEUZIL P,REDDY V Y,KAUTZNER J,et al.Electrical reconnection after pulmonary vein isolation is contingent on contact force during initial treatment:results from the EFFICAS I study[J].Circ Arrhythm Electrophysiol,2013,6(2):327-333.
[15]KAUTZNER J,NEUZIL P,LAMBERT H,et al.EFFICAS II:optimization of catheter contact force improves outcome of pulmonary vein isolation for paroxysmal atrial fibrillation[J].Europace,2015,17(8):1229-1235.
[16]FUJIWARA R,IMAMURA K,KIJIMA Y,et al.The importance of catheter stability evaluated by Visitag(TM)during pulmonary vein isolation[J].J Interv Card Electrophysiol,2016,46(2):161-166.
[17]MALCOLME-LAWES L C,LIM P B,KOA-WING M,et al.Robotic assistance and general anaesthesia improve catheter stability and increase signal attenuation during atrial fibrillation ablation[J].Europace,2013,15(1):41-47.
[18]LU H W,WEI P,JIANG S,et al.Pulmonary Vein Stenosis Complicating Radiofrequency Catheter Ablation:Five Case Reports and Literature Review[J].Medicine(Baltimore),2015,94(34):e1346.
[19]KUMAR N,AKSOY I,PISON L,et al.Management Of Pulmonary Vein Stenosis Following Catheter Ablation Of Atrial Fibrillation[J].J Atr Fibrillation,2014,7(1):1060.
[2]腾帅,白中乐,陶海龙,等.左心耳容积与心房颤动射频消融术后复发的关系[J].实用医学杂志,2018,34(9):1481-1484.
[3]LU F,LIN J,BENDITT D G.Conscious sedation and anesthesia in the cardiac electrophysiology laboratory[J].J Cardiovasc Electrophysiol,2013,24(2):237-245.
[4]DI B L,CONTI S,MOHANTY P,et al.General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation:results from a randomized study[J].Heart Rhythm,2011,8(3):368-372.
[5]CHIKATA A,KATO T,YAEGASHI T,et al.General anesthesia improves contact force and reduces gap formation in pulmonary vein isolation:a comparison with conscious sedation[J].Heart Vessels,2017,32(8):997-1005.
[6]MARTIN C A,CURTAIN J P,GAJENDRAGADKAR P R,et al.Improved outcome and cost effectiveness in ablation of persistent atrial fibrillation under general anaesthetic[J].Europace,2018,20(6):935-942.
[7]YAMAGUCHI T,SHIMAKAWA Y,MITSUMIZO S,et al.Feasibility of total intravenous anesthesia by cardiologists with the support of anesthesiologists during catheter ablation of atrial fibrillation[J].J Cardiol,2018,72(1):19-25.
[8]NOSEWORTHY P A,MALCHANO Z J,AHMED J,et al.The impact of respiration on left atrial and pulmonary venous anatomy:implications for image-guided intervention[J].Heart Rhythm,2005,2(11):1173-1178.
[9]ECTOR J,D E BUCK S,LOECKX D,et al.Changes in left atrial anatomy due to respiration:impact on three-dimensional image integration during atrial fibrillation ablation[J].J Cardiovasc Electrophysiol,2008,19(8):828-834.
[10]CHO J S,SHIM J K,NA S,et al.Improved sedation with dexmedetomidine-remifentanil compared with midazolam-remifentanil during catheter ablation of atrial fibrillation:a randomized,controlled trial[J].Europace,2014,16(7):1000-1006.
[11]GOUDRA B G,SINGH P M,CHANDRASEKHARA V.SEDASYS(?),airway,oxygenation,and ventilation:anticipating and managing the challenges[J].Dig Dis Sci,2014,59(5):920-927.
[12]BUN S S,LATCU D G,ALLOUCHE E,et al.General anesthesia is not superior to local anesthesia for remote magnetic ablation of atrial fibrillation[J].Pacing Clin Electrophysiol,2015,38(3):391-397.
[13]REDDY V Y,SHAH D,KAYTZNER J,et al.The relationship between contact force and clinical outcome during radiofrequency catheter ablation of atrial fibrillation in the TOCCATA study[J].Heart Rhythm,2012,9(11):1789-1795.
[14]NEUZIL P,REDDY V Y,KAUTZNER J,et al.Electrical reconnection after pulmonary vein isolation is contingent on contact force during initial treatment:results from the EFFICAS I study[J].Circ Arrhythm Electrophysiol,2013,6(2):327-333.
[15]KAUTZNER J,NEUZIL P,LAMBERT H,et al.EFFICAS II:optimization of catheter contact force improves outcome of pulmonary vein isolation for paroxysmal atrial fibrillation[J].Europace,2015,17(8):1229-1235.
[16]FUJIWARA R,IMAMURA K,KIJIMA Y,et al.The importance of catheter stability evaluated by Visitag(TM)during pulmonary vein isolation[J].J Interv Card Electrophysiol,2016,46(2):161-166.
[17]MALCOLME-LAWES L C,LIM P B,KOA-WING M,et al.Robotic assistance and general anaesthesia improve catheter stability and increase signal attenuation during atrial fibrillation ablation[J].Europace,2013,15(1):41-47.
[18]LU H W,WEI P,JIANG S,et al.Pulmonary Vein Stenosis Complicating Radiofrequency Catheter Ablation:Five Case Reports and Literature Review[J].Medicine(Baltimore),2015,94(34):e1346.
[19]KUMAR N,AKSOY I,PISON L,et al.Management Of Pulmonary Vein Stenosis Following Catheter Ablation Of Atrial Fibrillation[J].J Atr Fibrillation,2014,7(1):1060.