微创胸腔镜主动脉瓣置换手术患者术后重症监护的优化效果观察  

Optimization effect of minimally invasive thoracoscopic aortic valve replacement on postoperative intensive care of patients

作　　者：唐思宇 瞿雁 蒋欢 蔡涵晖 刘景全[2] 杨向红[2] TANG Siyu;QU Yan;JIANG Huan;CAI Hanhui;LIU Jingquan;YANG Xianghong(The Second School of Clinical Medicine,Zhejiang Chinese Medical University,Hangzhou 310053,China;不详)

机构地区：[1]浙江中医药大学第二临床医学院,杭州310053 [2]浙江省人民医院(杭州医学院附属人民医院)重症医学科

出　　处：《浙江医学》2024年第5期506-511,共6页Zhejiang Medical Journal

基　　金：浙江省科技厅省级重点研发计划项目(2019C03024);浙江省医药卫生科技计划项目(WKJ-ZJ-1811)。

摘　　要：目的 基于倾向性评分逆概率加权法分析微创胸腔镜手术(MIs)方式行主动脉瓣置换手术(AVR)对患者术后的重症监护的优化效果。方法 选取2019年8月至2022年6月在浙江省人民医院行AVR手术的患者265例。其中117例患者接受微创胸腔镜手术(MIs),为MIs组;148例患者接受胸骨切开术(MS),为MS组。患者术后均进ICU治疗。比较两组患者基线资料。采用倾向性评分逆概率加权法匹配两组患者,比较两组患者主要结局指标重症监护时长及次要结局指标重症监护期间伤口愈合不良、心律失常、肺炎、胸腔积液、卒中、低心排综合征、死亡、主动脉球囊反搏、体外膜肺氧合、气管切开、机械通气时长、术区引流总量、血浆用量、血小板用量、红细胞用量、血制品总用量、手术费用、总计费用以及住院总时间等。结果 两组患者急性生理与慢性健康评分、身高、性别、年龄、感染性心内膜炎、风湿病性心脏病、心肌病等指标比较差异均无统计学意义(均P>0.05)。与MS组比较,MIs组患者BMI较小、体重较轻、纽约心脏协会分级存在差异、冠心病较多、体外循环时间较短、阻断时间较短,差异均有统计学意义(均P<0.05)。采用倾向性评分逆概率加权法匹配后,两组患者基线资料比较差异均无统计学意义(均P>0.05);MIs组患者重症监护时长短于MS组(26 h比70 h,χ2=174.763,P<0.01);两组患者伤口愈合不良、心律失常、肺炎、胸腔积液、低心排综合征、死亡、主动脉球囊反搏、体外膜肺氧合、气管切开、血浆用量、血小板用量、红细胞用量、血制品用量、手术费用等指标比较差异均无统计学意义(均P>0.05);MIs组患者卒中发生较少、机械通气时间较短、术区引流总量较少、住院总计费用降低、住院总时间缩短,差异均有统计学意义(均P<0.05)。结论 患者在同等基线水平下,MIs下行AVR手术相比MS可优化术后监Objective This study aimed to analyze the optimization effect of minimally invasive thoracoscopic surgery(MIs) for aortic valve replacement(AVR) on postoperative intensive care of patients by using the propensity score inverse probability weighting method.Methods A total of 266 patients who underwent AVR surgery at Zhejiang Provincial People's Hospital from August 2019 to June 2022 were selected.Among them,117 patients received MIs(MIs group),and 149patients received conventional surgery(MS group).After surgery,all patients were admitted to the intensive care unit for treatment.Baseline data of the two groups were compared.The patients in both groups were matched using the propensity score inverse probability weighting method to ensure that their baseline characteristics were comparable without statistical differences.Subsequently,the duration of intensive care and the occurrence of postoperative complications during intensive care were compared between the matched groups.These complications included poor wound healing,arrhythmia,pneumonia,pleural effusion,stroke,low cardiac output syndrome,and death.Additionally,secondary outcome measures such as the use of interventions like aortic balloon counterpulsation,extracorporeal membrane oxygenation,tracheostomy,duration of mechanical ventilation,total drainage volume in the surgical area,plasma volume,platelet volume,red blood cell volume,total use of blood products,surgical cost,total cost,and total hospitalization time were also assessed.Results There were no statistically significant differences in the baseline data of acute physiology and chronic health evaluation,height,gender,age,infective endocarditis,rheumatic heart disease,cardiomyopathy,and others between the two groups(all P>0.05).Compared with the MS group,patients in the MIs group exhibited lower body mass index,lighter body weight,varied New York Heart Association classification,higher prevalence of coronary heart disease,shorter cardiopulmonary bypass time,and shorter cross-clamp time(all P<0.05).After

关 键 词：胸腔镜 微创外科手术 重症监护室 

分 类 号：R654.2[医药卫生—外科学]