成人再次开胸心脏手术疗效及其相关因素分析  

Effect analysis of repeat sternotomy in adult cardiac surgery

作　　者：林恒强 吕锋[1] 许建屏[1] 董超[1] 张怀军[1] 凤玮[1] 尹朝华[1] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院心外科,北京100037

出　　处：《心脏杂志》2018年第1期77-80,共4页Chinese Heart Journal

摘　　要：目的分析成人再次开胸心脏手术发生重大损伤的的相关因素及其对围手术期死亡率的影响。方法实施再次开胸心脏手术患者242例,回顾性分析再次手术间隔时间、前次手术方式及前次手术心包缝合情况对再次开胸心脏手术重大损伤发生率的影响及其对围手术期死亡率的影响。结果重大损伤发生率为2.1%(5/242),发生重大损伤组再次手术间隔时间与未发生重大损伤组差异无统计学意义[(8±5)年vs.(2±9)年],前次手术为冠状动脉旁路移植术的患者重大损伤的发生率与其他手术的患者差异无统计学意义(6.3%vs.1.8%),前次手术缝合心包的患者重大损伤的发生率与前次手术未缝合者差异无统计学意义(0%vs.7.4%),但二者开胸至体外循环开始时间差异有统计学意义[(57±20)min vs.(74±20)min,P<0.01];围手术期死亡率为1.7%(4/242),发生重大损伤的围手术期死亡率与未发生者差异无统计学意义(0%vs.1.7%)。结论成人再次开胸心脏手术较安全,发生重大损伤可能不增加围手术期死亡率。AIM To analyze risk factors for repeat sternotomy （RS） in adult cardiac surgery （CS） and to identify the impact on outcomes. METHODS A retrospective study was conducted by analyzing the data of 242 patients with RS of CS from September 2009 to September 2015 at the 55th Ward of Adult Cardiac Center in Fuwai Hospital. Continuous variables were analyzed using 2-sample t tests and categorical variables were compared using 2- or Fisher’s exact test. RESULTS Among the 242 patients, major injury （MI） occurred in 5 cases （2.1%） and no significant difference was found between the MI group and the non-MI group related to the interval since last sternotomy （8.3±5.0 years vs. 2.5±8.8 years, P=0.286）. Occurrence rate of MI was not statistically different between the primary coronary artery bypass graft and other operations （6.3% vs. 1.8%, P=0.292）, or between the pericardium had closed or not （0% vs. 7.4%, P=0.275）. The operative mortality rate was 1.7% （4/242） and the operative mortality among the patients with MI during RS was not statistically different with those without MI （0% vs. 1.7%, P=0.919）. CONCLUSION RS in adult CS is relatively safe and MI during RS is not a dangerous predictor of operative mortality.

关 键 词：再次开胸 心脏手术 重大损伤 

分 类 号：R541.9[医药卫生—心血管疾病]