目的:讨论胃镜检查中更加舒适的一种镇静镇痛方法。方法:芬太尼-异丙酚为Ⅰ组,咪唑安定-异丙酚组为Ⅱ组。观察记录各组术中的反应、胃镜操作时间、麻醉药物起效时间、苏醒时间和清醒时间,检查前中后BP、HR和SpO2的变化,及术后问卷调查。结果:Ⅰ组药物的起效快,受检者苏醒及清醒时间短,术中不适反应少,与Ⅱ组比较有统计学意义(Plt;0.01)。结论:镇静无痛苦胃镜检查中芬太尼-异丙酚联合用药更舒适。
ObjectiveTo investigate effectiveness and safety of transcatheter aortic valve replacement in the treatment of aortic regurgitation. Methods PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang Data and VIP were searched from inception to August 2021. According to the criteria of inclusion and exclusion, two reviewers independently screened the literature, extracted the data and evaluated the quality of the included studies. Then, Stata 16.0 software was used for meta-analysis. Subgroup meta-analysis of valve type used and study type was performed. ResultsTwenty-five studies (12 cohort studies and 13 single-arm studies) were included with 4 370 patients. Meta-analysis results showed that an incidence of device success was 87% (95%CI 0.81-0.92). The success rate of the new generation valve subgroup was 93% (95%CI 0.89-0.96), and the early generation valve subgroup was 66% (95%CI 0.56-0.75). In addition, the 30-day all-cause mortality was 7% (95%CI 0.05-0.10), the 30-day cardiac mortality was 4% (95%CI 0.01-0.07), the incidence of pacemaker implantation was 10% (95%CI 0.08-0.13), and the incidence of conversion to thoracotomy was 2% (95%CI 0.01-0.04). The incidence of moderate or higher paravalvular aortic regurgitation was 6% (95%CI 0.03-0.09). Conclusion Transcatheter aortic valve replacement for aortic regurgitation is safe and yields good results, but some limitations can not be overcome. Therefore, multicenter randomized controlled trials are needed to confirm our results.
Objective To systematically evaluate the impact of pulmonary hypertension (PH) on the prognosis of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Methods We conducted a computer-based search of databases including CNKI, WanFang Data, VIP, CBM, PubMed, The Cochrane Library, EMbase and Web of Science from the inception of the databases to June 2023. Two reviewers independently screened articles, extracted data and assessed the quality of the included studies. Meta-analysis was performed using Stata 17.0 software. Results A total of 16 cohort studies with Newcastle-Ottawa Scale score≥7 were included. Meta-analysis results demonstrated that patients with PH who underwent TAVR had significantly higher rates of all-cause mortality at 1 year [OR=2.10, 95%CI (1.60, 2.75), P＜0.01, I2=75%], 30 days [OR=2.09, 95%CI (1.54, 2.83), P＜0.01, I2=33%] and cardiovascular mortality [OR=1.49, 95%CI (1.18, 1.90), P＜0.001, I2=41%], compared to those without PH. There was no statistical difference between the two groups in major bleeding events, stroke, myocardial infarction, pacemaker implantation or postoperative renal failure. Subgroup analysis was conducted for some outcome indicators with significant heterogeneity from the aspects of PH measurement methods, PH diagnostic criteria and different PH types, and the results showed that most outcome indicators were subcombined and the direction was consistent with the overall result, and the heterogeneity was significantly reduced. Conclusion PH can significantly increase the 30 days, 1-year, and cardiovascular mortality rates in severe AS patients undergoing TAVR surgery.