右侧胸壁小切口与胸骨正中切口行心脏瓣膜置换术的对比研究  

Clinical comparison between the right chest small incision and the median sternal incision in heart valve replacement

作　　者：王宇 唐溢 文仁国 陈林 WANG Yu;TANG Yi;WEN Ren-guo;CHEN Lin(Department of Cardiovascular Surgery,Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院心血管外科,重庆400037

出　　处：《局解手术学杂志》2020年第3期235-238,共4页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨右侧胸壁小切口行心脏瓣膜置换手术的应用效果,并对比分析其较传统手术的优势。方法选择2017年12月至2018年12月在我院接受右侧胸壁小切口心脏瓣膜置换手术的50例患者作为小切口组,选择同期在我院接受传统胸骨正中切口心脏瓣膜置换手术的50例患者作为正中切口组。对比分析2组患者手术前后观测指标,包括术前心功能、术前射血分数、体外循环时间、主动脉阻断时间、手术时间、术中出血量、术后机械通气时间、术后无创呼吸机使用时间、术后ICU停留时间、住院时间(从手术日开始计算)、并发症等。结果小切口组术中出血量为(143.40±61.113)mL,正中切口组为(286.00±59.861)mL,组间比较差异有统计学意义(t=8.335,P=0.000);小切口组术后ICU停留时间为(2.28±1.061)d,正中切口组为(3.60±0.816)d,组间比较差异有统计学意义(t=-4.928,P=0.000);小切口组术后机械通气时间为(1.20±0.408)d,正中切口组为(1.76±0.597)d,组间比较差异有统计学意义(t=-3.871,P=0.049);小切口组体外循环时间为121(71~137)min,正中切口组为55(40~68)min,组间比较差异有统计学意义(Z=-6.068,P=0.000);小切口组主动脉阻断时间为81(41~97)min,正中切口组为40(27~48)min,组间比较差异有统计学意义(Z=-5.349,P=0.000);小切口组的手术时间为4.25(3.50~7.16)h,正中切口组为2.833(2.33~3.33)h,组间比较差异有统计学意义(Z=-6.073,P=0.000)。在术后无创呼吸机使用时间、住院时间、并发症发生率方面,2组患者比较差异无统计学意义(P>0.05)。结论与胸骨正中切口手术相比,右侧胸壁小切口心脏瓣膜置换手术在减少患者术中出血量、术后ICU停留时间、术后机械通气时间、手术切口美观度等方面优势明显,其手术方式安全可靠,更有利于患者术后恢复。Objective To explore the application effect of heart valve replacement surgery with right chest small incision,and compare with traditional surgery.Methods From December 2017 to December 2018,50 patients who underwent heart valve replacement surgery with right chest small incision in our hospital were selected as the small-incision group,a total of 50 patients who received heart valve replacement with traditional median sternal incision in our hospital during the same period were selected as the median incision group.The intraoperative and postoperative clinical data between the two groups were compared and analyzed,including preoperative cardiac function,preoperative ejection fraction,cardiopulmonary bypass time,aortic crossclamp time,operation time,intraoperative blood loss,postoperative mechanical ventilation time,postoperative non-invasive ventilation time,postoperative ICU duration,length of stay(calculated from the date of operation),complications,etc.Results The intraoperative blood loss of the small-incision group was(143.40±61.113)mL,and that of the median incision group was(286.00±59.861)mL,the difference between the two groups was statistically significant(t=8.335,P=0.000).Postoperative ICU duration of the small-incision group was(2.28±1.061)days,and that of the median incision group was(3.60±0.816)days,the difference between the two groups was statistically significant(t=-4.928,P=0.000).The postoperative mechanical ventilation time of the small-incision group was(1.20±0.408)days,and that of the median incision group was(1.76±0.597)days,the difference between the two groups was statistically significant(t=-3.871,P=0.049).The time of CPB in the small-incision group was 121(71 to 137)minutes,while that in the median incision group was 55(40 to 68)minutes,the difference between the two groups was statistically significant(t=-6.068,P=0.000).The aortic crossclamp time of the small-incision group was 81(41 to 97)minutes,and that of the median incision group was 40(27 to 48)minutes,the difference betwee

关 键 词：小切口 正中切口 微创手术 心脏手术 心脏瓣膜置换 

分 类 号：R542.5[医药卫生—心血管疾病]