胸腔镜下心脏不停搏二尖瓣置换术的心肺保护研究  

Study of heart and lung protection in thoracoscopic mitral valve replacement operation on beating-heart

作　　者：刘松涛[1] 牛玉旭 林辉[1] 温昭科[1] 梁胜景[1] 李香伟[1] Liu Songtao Niu Yuxu Lin Hui Wen Zhaoke Liang Shengjing Li Xiangwei(Department of Thoracic Cardiovascular Surgery,People＇s Hospital of Guangxi Zhuang Autonomous Region, Nanning , Guangxi 530021, China)

机构地区：[1]广西壮族自治区人民医院心胸血管外科/胸部外科,南宁530021

出　　处：《重庆医学》2017年第13期1729-1731,1735,共4页Chongqing medicine

基　　金：广西医疗卫生重点科研课题(重200962);广西壮族自治区卫生厅重点科研课题(重2011121;重2011112;重200521)

摘　　要：目的探讨胸腔镜与心脏不停搏技术结合的临床意义和价值,为临床手术方式的选择提供一定的参考。方法将该院胸心外科2012年9月至2015年9月收治的40例接受胸腔镜二尖瓣置换手术的风湿性心脏病-二尖瓣病变患者纳入研究。其中试验组(心脏不停搏组)20例,对照组(心脏停搏组)20例,将患者手术时间、体外循环时间、酶学指标、呼吸指数以及手术并发症等进行对比分析。结果两组各有1例患者死于术后低心排综合征,其余患者均顺利完成手术,术后均未出现低心排综合征、严重心律失常、空气栓塞等严重并发症,两组在手术时间、体外循环时间上差异无统计学意义(P>0.05),但ICU停留时间两组差异有统计学意义(P<0.05)。两组肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、乳酸脱氢酶(LDH)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)因子释放水平以及呼吸指数均有上升,但试验组水平显著低于对照组(P<0.05)。结论胸腔镜心脏不停搏二尖瓣置换术比胸腔镜心脏停搏二尖瓣置换术对心肺的保护效果更好。Objective To investigate the clinical significance of thoracoscopy combined with beating-heart technique to provide a certain reference for selecting clinical operation mode.Methods Forty patients with chronic rheumatic mitral stenosis receiving thoracoscopic mitral valve replacement surgery in the cardiothoracic surgery department of our hospital from September 2012 to September 2015 were included in this study and divided into the experimental group（beating-heart group,20cases）and control group（arrested heart group,20cases）.The operative time,CPB time,enzymology indicators,RI and operative complications were analyzed and compared between the two groups.Results One case in each group died of postoperative low cardiac output syndrome.Other cases successfully completed the operation without serious operative complications such as low cardiac output syndrome,serious cardiac arrhythmia and air embolism.Two groups had no statistically significant difference in the operation time and time of CPB（P〉0.05）,but the ICU staying duration had statistical difference between the two groups（P〈0.05）.The levels of CK-MB,cTnI,LDH,TNF-α,IL-6,IL-8and RI were significantly increased in two groups（P〈0.05）,while the levels in the experimental group were significantly lower than those in the control group（P〈0.05）.Conclusion Thoracoscopic mitral valve replacement operation with beating-heart may have better protection effect on heart and lung than thoracoscopic arrested-heart mitral valve replacement operation.

关 键 词：胸腔镜 心脏不停搏 二尖瓣置换术 心肺保护 

分 类 号：R654.2[医药卫生—外科学]