全胸腔镜下二尖瓣置换手术的安全性研究  

Safety of total thoracoscopic cardiac surgery

作　　者：万丽丽[1] 曾祥军 Wan Lili;Zeng Xiangjun(Department of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;Department of Heart Surgery, Kaide Hospital of Cardiovascular Diseases, Zhuzhou 412000, China)

机构地区：[1]华中科技大学同济医学院附属同济医院心脏大血管外科,武汉430030 [2]北大医疗株洲恺德心血管病医院心脏外科,412000

出　　处：《中华实验外科杂志》2019年第8期1479-1481,共3页Chinese Journal of Experimental Surgery

摘　　要：目的探讨全胸腔镜下行心脏手术的临床效果.方法选取2014年8月至2017年11月期间武汉亚洲心脏病医院和北大医疗株洲凯德心血管病医院所收治行二尖瓣膜置换手术患者110例,按照手术方法的不同将其分为观察组(全胸腔镜下心脏手术)和对照组(传统正中开胸手术),两组患者的手术资料分析.结果两组患者术中输血量、手术时间差异无统计学意义(t=0.710、1.610,P> 0.05);但观察组患者主动脉阻断时间[(40.5±6.8)min]、体外循环时间[(73.6±12.7)min]均明显长于对照组[(34.7±7.1)、(58.9±11.6)min],差异有统计学意义(t=4.380、6.340,P<0.05);观察组患者重症监护室(ICU)时间[(36.8±4.7)h]、呼吸机辅助时间[(17.1±41.9) h]、住院时间[(9.5±1.1)d]均明显短于对照组[(45.5±6.2)h、(23.5±2.1)h、(14.8±2.9)d],且观察组胸管引流量[(2.9±0.3)ml/kg]明显少于对照组[(7.9±1.6) ml/kg],差异有统计学意义(t=-8.290、-16.760、-12.670、-4.410,P<0.05);两组患者术前心律失常比例、术后心率改善比例差异无统计学意义(x2=0.146、0.017,P>0.05),但观察组患者术后镇痛药使用比例10例(18.18%)明显低于对照组29例(52.73%),差异有统计学意义(x2=14.341,P<0.05).结论全胸腔镜下心脏手术同传统正中开胸手术均是有效的二尖瓣瓣膜置换术方法,两者安全性相当,其中在合理把握适应证的前提下,全胸腔镜下心脏手术可有效减轻手术创伤,减少术后引流,促进患者术后尽快恢复,对于改善患者生活质量具有积极作用.Objective To explore the clinical effect of total thoracoscopic cardiac surgery. Methods A total of 110 patients undergoing mitral valve replacement surgery were enrolled in our hospital from August 2014 to November 2017 .They were divided into observation group (total thoracoscopic heart surgery) and control group (traditional center) according to different surgical methods. The surgical data were retrospectively analyze in the two groups. Results There was no significant difference in intraoperative blood transfusion and operation time between the two groups (t=0.710 and 1.610;P>0.05), but the aortic block time and extracorporeal circulation time in the observation group were significantly longer than those in the control group (t=4.380 and 6.340;P<0.05). The duration of aortic occlusion [(40.5±6.8) min] and CPB [(73.6±12.7) min] in the observation group were significantly longer than those in the control group [(34.7±7.1) min and (58.9±11.6) min](t=4.380, 6.340, P<0.05). The intensive care unit (ICU) time [(36.8±4.7) h], ventilator assisted time [(17.1±41.9) h], and hospitalization time [(9.5±1.1) days] in the observation group were significantly shorter than those in the control group [(45.5±6.2) h,(23.5±2.1) h, and (14.8±2.9) days], and the thoracic duct drainage volume [(2.9±0.3) ml/kg] was significantly less than that in the control group (7.9±1.6) ml/kg (t=-8.290,-16.760,-12.670,-4.410, P<0.05). There was no significant difference in the proportion of preoperative arrhythmia and postoperative heart rate improvement between the two groups (χ2=0.146 and 0.017;P>0.05), and the proportion of postoperative analgesics used in 10 patients (18.18%) in the observation group was significantly lower than that in 29 patients (52.73%) in the control group (χ2=14.341, P<0.05). Conclusion Total thoracoscopic cardiac surgery and traditional median thoracotomy are effective mitral valve replacement methods, and the safety of the two is equivalent. Under the premise of reasonable understanding of the indicati

关 键 词：二尖瓣膜置换手术 全胸腔镜手术 正中开胸手术 安全性 

分 类 号：R654.2[医药卫生—外科学]