一站式非心脏疾病手术同期心脏直视手术实践分析  

Analysis of hybrid cardiac and non-cardiac operations

作　　者：王怀斌[1] 甄文俊[1] 欧阳小康[1] 马玉健[1] 谭洁[1] 罗文琦[1] 王子[1] 

机构地区：[1]北京医院心血管外科,100730

出　　处：《中华胸心血管外科杂志》2018年第1期22-25,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 探讨一站式非心脏疾病手术同期心脏直视手术治疗效果.方法 总结2000年至2016年11例复合手术病例资料.按照心脏手术相关特征配对原则选取11例单纯心脏直视手术患者设为对照组.分别测定记录围手术期心肌同工酶（CK-MB）、血肌钙蛋白（TNI）,以及术后视觉模拟（VAS）痛觉评分.比较两组患者住院费用和术后住院天数.结果 两组均无手术及住院死亡,未发生伤口感染、延期愈合、术后活动性出血需二次开胸止血、恶性心律失常、脑梗塞等严重并发症.复合手术组手术时间明显长于对照组[（358±79）min对（224±56）min,P〈0.01];异体红细胞[（3.2±1.6）U/例对（1.1±0.8）U/例,P〈0.05]和血浆[（515±234）ml/例对（284±92）ml/例,P〈0.01]输注量明显多于对照组.围手术期CK-MB和TNI组间差异无统计学意义（P〉0.05）.VAS评分显示,单纯心脏手术后伤口疼痛轻微,复合手术后伤口疼痛为中等强度,对于患者术后咳嗽、咳痰等康复运动影响不大.均数对比显示,复合手术组人均住院费用比单纯心脏手术组多2.3万元,术后住院天数长4天.除1例不稳定心绞痛合并乙状结肠癌低位肠梗阻患者（接受心包剥脱及CABG手术后剖腹探查未能切除肿瘤,术后3周死于肠梗阻恶液质）,余10例均治愈出院.随访6～20个月,未发生严重心血管事件,未发现肿瘤复发及转移.结论 实践证明,术前多学科联合评估,整合设计制定个性化手术方案;术中手术医师、麻醉医师以及手术护士通力协作;术后严密监护,精心护理,一站式复合手术避免了分期手术造成的延误病情及增加围手术期心源性风险等不利因素,避免了患者接受第二次手术的痛苦,安全有效. Objective Analysis of hybrid cardiac and non-cardiac operations.Methods 11 patients received hybrid operations during 2000 ～2016 in our hospital were summarized, meanwhile another 11 patients undergoing only cardiac sur-gery served as controls.The level of CK-MB, TNI and visual analogue pain scores were recorded.The hospitalization expenses and postoperative hospital time were compared between the two groups .Results There was no death during hospitalization . There were no serious complications such as wound infection, delayed wound healing, postoperative bleeding requiring re-thora-cotomy and hemostasis, malignant arrhythmia, cerebral infarction and so on.Longer operation time[（358 ±79）min vs.（224 ±56）min, P〈0.01], more allogeneic red blood cells transfusion[（3.2 ±1.6）U/case vs.（1.1 ±0.8）U/case, P〈0.05] and more plasma transfusion[（515 ±234）ml/case vs.（284 ±92）ml/case, P〈0.01]in hybrid operation group than those in the control group.There was no significant difference about CK-MB and TNI between two groups perioperatively（P〉0.05）. The wound pain was mild after cardiac surgery , and the wound pain was moderate after hybrid operation , which had little effect on rehabilitation exercises such as cough.4 days longer of postoperative hospital stay and 23 thousand yuan of hospitalization cost in hybrid operation group than those in the control group.One patient diagnosed of unstable angina pectoris and sigmoid colon cancer with intestinal obstruction was failed to resection of the tumor after received pericardial stripping and coronary ar-tery bypass surgery.The patient died three weeks after surgery due to intestinal obstruction and cachexia .The remaining 10 pa-tients were underwent successful surgery, cured and left hospital.No serious cardiovascular events, tumor recurrence and me-tastasis were found as followed up for 6-20 months.Conclusion Our practices show that hybrid cardiac and non-cardiac op-erations can be done safely and effectively.

关 键 词：心脏外科手术 体外循环 冠状动脉分流术 心脏瓣膜假体植入 同期手术 

分 类 号：R654.2[医药卫生—外科学]