二尖瓣成形术后再次开胸的安全性分析  

Repeated sternotomy after mitral valve repair: no longer a risk factor

作　　者：仲肇基 岳子祺 赵振华 许建屏 吕锋 王水云 王欣 刘盛 ZHONG Zhaoji YUE Ziqi ZHAO Zhenhua XU Jianping LU Feng WANG Shuiyun WANG Xin LIU Sheng(Department of Cardiovascular Surgery, Fu Wai Hospital, Chinese Academy of Medical Science, Beijing, 100037, P.R. China)

机构地区：[1]中国医学科学院阜外医院心外科,北京100037

出　　处：《中国胸心血管外科临床杂志》2017年第1期30-35,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：首都临床特色应用研究与推广(Z151100004015107);北京协和医学院"协和青年基金"(3332015105)

摘　　要：目的探讨二尖瓣成形术后再次开胸的并发症及预防策略,评估二尖瓣成形术后再次开胸的安全性。方法回顾性分析我院2009年1月至2015年6月二尖瓣成形术后再次开胸的非风湿性二尖瓣病变88例患者的临床资料,男53例、女35例,年龄(36.1±17.5)岁,作为再次开胸组。随机选取同期进行的初次二尖瓣成形术88例患者作为初次开胸组,男57例、女31例,年龄(39.9±12.6)岁。分析二尖瓣成形术后再次开胸的并发症和开胸策略,与同期进行的初次二尖瓣成形术比较。结果再次开胸组未发生主要组织损伤。再次开胸组8例(9.1%)采用预防性股动脉插管,股动脉插管组平均体外循环时间长于主动脉插管组[(155.5±59.0)min vs.(119.5±39.9)min,P=0.023],而主动脉阻断时间差异无统计学意义(P=0.786)。再次开胸组8例(9.1%)选择开放胸膜经心包外入路,经心包外组和常规游离组体外循环时间(P=0.255)、主动脉阻断时间(P=0.360)差异均无统计学意义。再次开胸组不同开胸策略术后并发症差异无统计学意义(P>0.05)。再次开胸组体外循环时间[(123.0±3.0)min vs.(95.4±37.1)min,P=0.000]、主动脉阻断时间[(79.0±36.3)min vs.(67.5±29.1)min,P=0.026]均长于初次开胸组,但两组术后左心室射血分数(LVEF)、左心室舒张期末内径(LVEDD)、围手术期并发症、围手术期输血、ICU停留时间、住院时间等指标差异均无统计学意义(P>0.05)。结论二尖瓣成形术后再次开胸的安全性可以通过合适的开胸策略得到保证。远期需要再次开胸不应成为选择二尖瓣成形术的顾虑。Objective To explore the safety and complications of repeated sternotomy after mitral valve repair and prevention strategies. Methods We retrospectively analyzed the clinical data of 88 consecutive patients of non-rheumatic mitral valve disease who underwent repeated sternotomy for failure of first-time mitral valve repair in our hospital from January 2009 through June 2015. There were 53 males and 35 females with a mean age of 36.1±17.5 years in the patients who underwent repeated sternotomy. Meanwhile 88 patients who underwent the first-time sternotomy for mitral valve repair simultaneously were randomly recruited as a control group, and there were 57 males and 31 females with a mean age of 39.9±12.6 years. The clinical outcomes were analyzed retrospectively and compared between the two groups. Results No major injury was observed in the patients who underwent repeated sternotomy. Eight patients （9.1%） in the repeated sternotomy group required femoral artery cannulation. Cardiopulmonary bypass （CPB） time was longer in the femoral artery cannulation group than that in the aortic cannulation group （155.5±59.0 minvs. 119.5±39.9 min,P=0.023）. While there was no statistical difference in aortic cross-clamp time （P=0.786）. Eight patients （9.1%） in the repeated sternotomy group used extra-pericardium approach. There was no significant difference in CPB time （P=0.255） or aortic cross-clamp time （P=0.360） between the patients who used extra-pericardium approach and those used routine approach. There was no statistical difference in post-operative complications between the patients who used different sternotomy strategies. Although CPB time （123.0±3.0 minvs. 95.4±37.1 min,P=0.000） or aortic cross-clamp time （79.0±36.3 minvs. 67.5±29.1 min,P=0.026） was longer in the repeated sternotmy group, the major outcomes were similar between the repeated sternotmy group and the first-time sternotmy group （P〉0.05）. Conclusion Repeated sternotomy after mitral valve repair is relatively

关 键 词：二尖瓣成形术 再次开胸 安全性 

分 类 号：R654.2[医药卫生—外科学]