经右胸切口微创二尖瓣置换术的学习曲线研究  

Learning Curve of Mitral Valve Replacement through Right Minithoracotomy

作　　者：吴先球[1] 韦武利[1] 王奇[1] 何毅[2] 

机构地区：[1]广西医科大学第四附属医院心胸外科,广西柳州545005 [2]广西医科大学第四附属医院病案统计室,广西柳州545005

出　　处：《中国胸心血管外科临床杂志》2014年第5期614-618,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：广西柳州市应用技术研究与开发计划之科技创新与能力建设项目(2010030719)~~

摘　　要：目的应用累积和分析法（culmulative sum analysis,CUSUM analysis）监测右胸切口微创二尖瓣置换术的手术质量,并分析其学习曲线。方法分析2011年6月至2013年4月广西医科大学第四附属医院连续60例右胸切口微创二尖瓣置换术患者的临床资料,其中男32例、女28例,年龄28～53（34.67±7.11）岁;心功能分级（NYHA）Ⅱ～Ⅳ级。二尖瓣狭窄31例,二尖瓣关闭不全19例,二尖瓣狭窄伴关闭不全10例。按手术时间顺序为每一例患者进行编号,并分为A组、B组、C组,每组20例患者。收集并分析3组患者的各项手术指标,同时使用描述性统计方法及累积和分析曲线对手术质量进行分析。结果 C组主动脉阻断时间、体外循环时间和手术时间明显短于A组和B组[C组主动脉阻断时间与A组比较：（50.35±2.30）min vs.（66.15±8.38）min;C组手术时间与B组比较：（167.50±4.63）min vs.（178.60±4.49）min,P〈0.05];全部患者的院内死亡率为3.3%（2/60）。累积和分析法分析结果显示,尽管在研究期间内,手术质量均在控制范围内,但存在明显的学习曲线效应,术者在进行了约45例手术实践后,其手术累积失败率低于80%警戒线,即其手术失败率低于预期的10%。结论微创二尖瓣手术是安全、有效的,而CUSUM法是一种简单、监控手术质量的统计方法。Objective To monitor surgical quality and analyze learning curve of minimally invasive mitral valve replacement （MVR） through right minithoracotomy with cumulative sum analysis （CUSUM analysis）. Methods Clinical data of 60 consecutive patients who underwent minimally invasive MVR through right minithoracotomy in the Fourth Affiliated Hospital of Guangxi Medical University from June 2011 to April 2013 were retrospectively analyzed. There were 32 male and 28 female patients with their age of 28-53 （34.67_ 7.11 ） years and their heart function ranging from NYHA class II to IV. There were 31 patients with mitral stenosis （MS）, 19 patients with mitral regurgitation （MR）, and 10 patients with MS and MR. According to the surgical sequence, all the patients were divided into 3 groups （group A, B and C）with 20 patients in each group. Surgical outcomes were compared among the 3 groups, and surgical quality was analyzed with descriptive statistics and CUSUM curves. Results Aortic cross-clamp time, cardiopulmonary bypass time and operation time of group C were significantly shorter than those of group A and group B （aortic cross-clamp time of group C vs. group A.. 50.35 ± 2.30 minutes vs. 66.15 ± 8.38 minutes; operation time of group C vs. group B ： 167.50±4.63 minutes vs. 178.60 ± 4.49 minutes, P 〈 0.05 ）. In-hospital mortality was 3.3% （2/60）. CUSUM analysis showed a significant learning curve effect, although surgical quality remained in control during the study period. Surgical failure rate was lower than 80% after about 45 operations, indicating that failure rate was 10% lower than expectation. Conclusion Minimally invasive MVR is safe and reliable, and CUSUM analysis is a simple statistical method to monitor surgical quality.

关 键 词：微创二尖瓣置换术 累积和分析法 学习曲线 质量控制 

分 类 号：R654.2[医药卫生—外科学]