右胸前外小切口封堵术在房间隔缺损中的应用及对心脏重构的影响  

Application of right thoracic anterolateral small incision closure in atrial septal defect and its influence on cardiac remodeling of patients

作　　者：曲政[1] 尤斌[1] 李平[1] 徐屹[1] 许李力[1] 刘硕[1] 李光[1] 张竞为 QU Zheng;YOU Bin;LI Ping;XU Yi;XU Lili;LIU Shuo;LI Guang;ZHANG Jingwei(Department of Cardiac Surgery,Capital Medical Unicersity affiliated Beijing Anzhen Hospital,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科,100029

出　　处：《心肺血管病杂志》2021年第4期349-353,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探究右胸前外小切口封堵术在房间隔缺损(ASD)中的应用及对患者心脏重构的影响。方法:回顾性分析于我院2015年1月至2019年12月,接受治疗的175例ASD患者的临床资料,并根据其治疗方法进行分组,传统体外循环(CPB)直视修补术治疗为对照组80例,右胸前外小切口封堵术治疗为观察组95例。比较两组围手术期指标,术前、术后6个月的心功能分级[纽约心脏学会(NYHA)分级]、心脏重构指标[右心房内径(RAd)、右心室内径(RVd)、(LAd)、LVDd]变化,并记录两组术后相关并发症发生情况。结果:观察组患者手术时间、呼吸机辅助时间、切口长度、胸腔引流量、下床时间、住院时间均明显低于对照组(P均<0.05);术后6个月,两组患者NYHA分级均明显降低(P<0.05),而两组术前、术后6个月组间比较,差异无统计学意义(P>0.05);术后6个月,两组患者RAd、RVd较治疗前均有显著下降(P均<0.05),LVDd较治疗前均有显著上升(P均<0.05),而LAD比较无统计学意义(P>0.05),两组术后6个月RAd、RVd、LAD、LVDd水平比较均无统计学意义(P>0.05);观察组心律失常发生率及并发症总发生率均明显低于对照组(P均<0.05)。结论:右胸前外小切口封堵术可明显改善ASD患者心功能,疗效理想,具有手术时间短、切口小、术后住院时间短等优势,且安全性高,值得推广。Objective:To explore the application of right thoracic anterolateral small incisionclosure in the treatment of atrial septal defect(ASD)and its influence on cardiac remodeling of patients.Methods:The clinical data of 175 patients with ASD who were treated in our hospital from January 2015 to December 2019 were retrospectively analyzed,and the patients were grouped according to thetreatment method.Among them,80 patients in control group received traditional cardiopulmonary bypass(CPB)surgical repair under direct vision,and 95 patients in observation group were treated withright thoracic anterolateral small incision closure.The perioperative indicators,and cardiac function classification[New York Heart Association(NYHA)classification],cardiac remodeling indicators[right atrial diameter(RAd),right ventricular diameter(RVd),LAD,LVDd]before surgery and at 6 months after surgery were compared between the two groups,and the occurrence of postoperative related complications were recordedin the two groups.Results:The surgical time,ventilator assisted time,incision length,thoracic drainage volume,ambulation time and hospital stay in observation group were significantly lower than those in control group(all P<0.05).At 6 months after surgery,the NYHA classification in the two groups was significantly reduced(P<0.05),but there was no statistically significant difference between the two groups before surgery and at 6 months after surgery(P>0.05).At 6 months after surgery,the RAd and RVd in the two groups were significantly decreased compared with those before treatment(all P<0.05)while the LVDd was significantly increased compared with that before treatment(all P<0.05),but there was no statistically significant difference in the LAD(P>0.05),and there were no statistically significant differences in the RAd,RVd,LAD and LVDd between the two groups at 6 months after surgery(P>0.05).The incidence rate of arrhythmia and total incidence rate of complications in observation group were significantly lower than those in control group(P

关 键 词：右胸切口 封堵术 房间隔缺损 并发症 临床疗效 心功能 微创 

分 类 号：R54[医药卫生—心血管疾病]