右腋下小切口入路手术治疗先天性心脏病患儿的临床疗效  

Clinical effect of right subaxillary small incision approach on children with congenital heart disease

作　　者：王鹏高 张宇 陈忠建 崔亚洲 于文波[1] 董向阳[1] Wang Penggao;Zhang Yu;Chen Zhongjian;Cui Yazhou;Yu Wenbo;Dong Xiangyang(Department of Thoracic and Cardiovascular Surgery,Children′s Hospital Affiliated to Zhengzhou University,Henan Children′s Hospital,Zhengzhou Children′s Hospital,Zhengzhou 450000,China;Institute of International Education,Xin-xiang Medical University,Xinxiang 453003,Henan Province,China)

机构地区：[1]郑州大学附属儿童医院,河南省儿童医院,郑州儿童医院胸心外科,郑州450000 [2]新乡医学院国际教育学院,河南新乡453003

出　　处：《中华实用儿科临床杂志》2020年第1期41-45,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的分析右腋下小切口入路手术在先天性心脏病(CHD)患儿中的应用价值。方法选取2015年1月至2017年9月河南省儿童医院收治的86例CHD患儿,按简单随机法分为对照组和观察组,每组各43例。对照组实施胸骨正中切口手术,观察组实施右腋下小切口入路手术,比较2组总有效率、切口满意度、手术一般情况(体外循环时间、手术时间、主动脉阻断时间、术中失血量)、术后相关情况(胸腔引流量、术后监护时间、术后辅助通气时间、住院时间、住院费用)、Wong-Baker面部表情量表(FPS-R)评分、麻醉后(T1)、术毕(T2)、入监护病房(T3)、拔管前(T4)呼吸功能指标,即呼吸道峰压(PIP)及肺泡气-动脉血氧分压差[p(A-a)(O2)]水平及并发症发生率。结果1.观察组切口满意度[90.70%(39/43例)]高于对照组[62.79%(27/43例)],2组比较差异有统计学意义(χ2=9.382,P=0.002)。2.观察组体外循环时间、手术时间、主动脉阻断时间分别为(68.94±8.26)min、(2.33±0.21)h、(28.79±7.32)min,与对照组[(67.11±9.11)min、(2.25±0.31)h、(30.02±6.88)min]比较差异均无统计学意义(均P>0.05)。3.观察组术中失血量[(89.87±11.25)mL]少于对照组[(105.91±31.01)mL],差异有统计学意义(t=3.189,P=0.002)。4.观察组术后监护时间[(30.55±10.39)h]、术后辅助通气时间[(9.68±2.19)h]、住院时间[(9.61±2.17)d]、胸腔引流量[(90.36±26.14)mL]、住院费用[(36956.15±1097.84)元]均低于对照组[(41.39±9.93)h、(12.72±3.81)h、(12.33±3.15)d、(163.24±29.36)mL、(45271.97±1134.55)元],差异均有统计学意义(t=4.946、4.536、4.663、12.157、34.540,均P<0.01)。5.观察组术后1 d、2 d、3 d、4 d FPS-R评分分别为(4.02±0.41)分、(3.41±0.15)分、(2.55±0.20)分、(1.16±0.27)分,低于对照组[(5.21±0.89)分、(5.02±0.63)分、(4.12±0.67)分、(3.05±0.39)分],差异均有统计学意义(t=7.963、16.302、14.724、26.128,均P<0.01)。6.观察组T1、T2、T3、T4时刻p(A-a)(O2)及PIP与Objective To analyze the clinical effect of right subaxillary small incision approach on children with congenital heart disease(CHD).Methods Eighty-six patients with CHD admitted to Henan Children′s Hospital from January 2015 to September 2017 were enrolled in this study.The patients were randomly divided into the control group and the observation group with 43 cases each group.The control group underwent sternal median incision,and the observation group underwent right subaxillary small incision.The total effective rate,incision satisfaction,general conditions of surgery(cardiopulmonary bypass time,operation time,aortic occlusion time,intraoperative blood loss),postoperative related conditions(thoracic drainage volume,postoperative monitoring time,postoperative assisted ventilation time,hospitalization time,hospitalization expenses),Wong-Baker facial expression scale(FPS-R)score,as well as the respiratory function index including the levels of peak inspiratory pressure(PIP)and alveolar-arterial oxygen pressure difference[p(A-a)(O2)]after anesthesia(T1),after operation(T2),at admission to intensive care unit(T3)and before extubation(T4)and complication rate between 2 groups were compared.Results(1)The incision satisfaction in the observation group[90.70%(39/43 cases)]was higher than that in the control group[62.79%(27/43 cases)],and the difference was statistically significant(χ2=9.382,P=0.002).(2)There was no significant difference in the the extracorporeal circulation time,operation time and aortic block time between the two groups[observation group:(68.94±8.26)min,(2.33±0.21)h,(28.79±7.32)min;control group:(67.11±9.11)min,(2.25±0.31)h,(30.02±6.88)min](P>0.05).(3)The intraoperative blood loss[(89.87±11.25)mL]in the observation group was less than that in the control group[(105.91±31.01)mL],which difference was statistically significant(t=3.189,P=0.002).(4)Also there was significant difference in postoperative monitoring time,postoperative assisted ventilation time,hospitalization time,thoracic draina

关 键 词：微创 胸骨正中切口 先天性心脏病 右腋下小切口 儿童 直视手术 

分 类 号：R726[医药卫生—儿科]