微创切口与胸骨正中切口主动脉瓣置换术中倾向性评分匹配的对比研究  

Minimally invasive incisions versus conventional median sternotomy incision for aortic valve replacement:A propensity score matching study

作　　者：张永会 张林[1] 李梁钢 任瞳 龚志云[1] 王瑶[1] 赵元程 曲帅 姜胜利[1] ZHANG Yong-hui;ZHANG Lin;LI Liang-gang;REN Tong;GONG Zhi-ywi;WANG Yao;ZHAO Yuan-cheng;QU Shuai;JIANG Sheng-li(Department of Cardiovascular Surgery,Chinese PLA General Hospital No.1 Medical Center,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心心血管外科

出　　处：《中国心血管病研究》2019年第12期1079-1083,共5页Chinese Journal of Cardiovascular Research

基　　金：全军保健专项(16BJZ28)~~

摘　　要：目的对比研究微创切口与胸骨正中切口主动脉瓣置换术的术后早期临床效果与安全性。方法回顾性分析2012年1月至2018年8月解放军总医院第一医学中心心血管外科完成的308例单纯首次主动脉瓣置换术患者的临床资料,其中微创切口(右胸肋间切口或胸骨上段切口)60例(微创组),常规胸骨正中切口248例(常规组)。利用倾向性评分匹配方法对两组患者的临床资料进行对比分析结果常规组患者术后早期死亡1例,二次开胸探查止血2例。倾向性评分匹配后,60对患者纳入分析,两组患者术前基线资料比较差异无统计学意义。微创组患者手术时间、CPB时间和主动脉阻断时间均大于常规组[分别为(233.00±36.34)min比(215.42±35.57)min,(106.27±27.64)min比(89.13±22.89)min,(84.35±23.02)min比(69.08±21.37)min],差异均有统计学意义(P<0.05)。微创组术后ICU停留时间小于常规组[2(2~3)d比3(2~4)d],差异有统计学意义(P<0.001)。微创组术后当天引流量小于常规组[360(230~520)ml比495(360~665)ml],差异有统计学意义(P=0.001)。微创组新发房颤率低于常规组(10%比30%),差异有统计学意义(P=0.006)。结论与常规胸骨正中切口相比,微创切口可安全有效的应用于主动脉瓣置换术,并且术后引流量更少、新发房颤率更低、美容效果更好。Objective To compare the postoperative early clinical outcomes and safety of minimally invasive incisions and median sternotomy incision for aortic valve replacement(AVR).Methods Clinical data of308 patients undergone primary AVR along between January 2012 and August 2018 in the Department of Cardiovascular Surgery,General Hospital of Chinese PLA No.1 Medical Center were retrospectively reviewed.There were 60 patients underwent AVR via minimally invasive incisions(mini-AVR group)including right anterior minithoracotomy and upper mini-sternotomy and 248 patients via conventional sternotomy(conventional AVR group).A propensity score matching analysis was performed for the comparison.Results In conventional AVR group,one patient died postoperatively and two underwent reexploration for bleeding.Propensity score matching yielded 60 pairs of patients in which there were no significant differences in baseline profiles between the two groups.The operation time[(233.00±36.34)min vs.(215.42±35.57)min,P=0.008],cardiopulmonary bypass time[(106.27±27.64)min vs.(89.13±22.89)min,P<0.001]and aortic cross-clamp time[(84.35±23.02)min vs.(69.08±21.37)min,P<0.001]of mini-AVR group were longer than those of conventional AVR group but the Intensive Care Unit(ICU)stay time[2(2-3)days vs.3(2-4)days,P<0.001]was shorter than that of conventional AVR group.The postoperative drainage volume[360(230-520)ml vs.495(360-665)ml]of miniAVR group was less than that of conventional AVR group(P<0.05)and the rate of new-onset atrial fibrillation(10%vs.30%)was lower than that of conventional AVR group(P<0.05).Conclusion Minimally invasive incisions can be applied to aortic valve replacement safely and effectively with less postoperative drainage,lower new-onset atrial fibrillation rates and better cosmetic results.

关 键 词：主动脉瓣置换术 右胸肋间切口 胸骨上段切口 微创 倾向性评分匹配 

分 类 号：R654.2[医药卫生—外科学]