中低温心肺转流诱导心室颤动下全胸腔镜再次二尖瓣手术的临床分析  

Therapeutic strategy for totally thoracoscopic repeat mitral valve surgery under moderate hypothermia-induced ventricular fibrillation

作　　者：何潇一 张林[1] 李东[1] 李梁钢 董士勇 申宏 姜胜利[1] He Xiaoyi;Zhang Lin;Li Dong;Li Lianggang;Dong Shiyong;Shen Hong;Jiang Shengli(Department of Cardiovascular Surgery,the First Medical Center of People′s Liberation Army General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心心脏大血管外科,北京100853

出　　处：《中华外科杂志》2024年第5期387-392,共6页Chinese Journal of Surgery

摘　　要：目的探讨中低温心肺转流诱导心室颤动下全胸腔镜再次二尖瓣手术的围手术期结果,以及影响术后早期频发室性期前收缩的因素。方法本研究为回顾性病例系列研究。回顾性分析2021年1月至2023年12月在解放军总医院第一医学中心心脏大血管外科由同一术者实施的63例再次二尖瓣手术的患者资料。男性28例,女性35例,年龄(58.3±15.9)岁(范围:13~84岁)。手术通过全胸腔镜入路完成,采用中低温心肺转流诱导心室颤动性停搏,二尖瓣成形32例,二尖瓣置换31例。收集患者术前基线资料及围手术期结果,采用Logistic回归分析术后早期频发室性期前收缩的独立影响因素。结果术中心肺转流时间(191.5±50.9)min(范围:95~286 min),术中低温心室颤动时间(99.0±39.8)min(范围:34~203 min)。转机前肛温(36.3±0.5)℃(范围:35.2~38.0℃),术中最低肛温(27.3±1.3)℃(范围:23.7~30.1℃),停机时肛温(36.3±0.4)℃(范围:35.2~37.0℃),超越复温33例。术后需要人工心脏辅助装置维持循环6例,术后早期频发室性期前收缩17例,神经系统并发症2例,呼吸系统并发症5例,泌尿系统并发症1例。机械通气时间>3 d 6例,ICU停留时间>3 d 16例,术后住院时间[M(IQR)]8.0(3.5)d(范围:3~26 d),死亡或自动出院2例。Logistic回归结果显示,术前持续性心房颤动(OR=11.424,95%CI:1.477~144.564,P=0.033)和超越复温(OR=15.249,95%CI:1.357~279.571,P=0.038)是术后早期频发室性期前收缩的独立影响因素。结论中低温心肺转流诱导心室颤动下全胸腔镜手术可用于再次二尖瓣手术。术前持续性心房颤动和超越复温是术后早期频发室性期前收缩的独立危险因素。Objective To examine the therapeutic strategy and its impacting factors by analyzing the perioperative outcomes of total thoracoscopic repeat mitral valve surgery under moderate hypothermia-induced ventricular fibrillation with cardiopulmonary bypass.Methods This study is a retrospective case series.Totally 63 patients who underwent repeat mitral valve surgery by the same surgeon from January 2021 to December 2023 in Department of Cardiovascular Surgery,the First Medical Center of People′s Liberation Army General Hospital were retrospectively enrolled.There were 28 males and 35 females with an age of(58.3±15.9)years(range:13 to 84 years).Surgery was performed using a totally thoracoscopic approach under moderate hypothermia-induced ventricular fibrillation.Mitral valvuloplasty was completed in 32 cases and mitral valve replacement in 31 cases.Preoperative baseline data and perioperative outcomes of the patients were collected and Logistic regression was used to analyze independent influencing factors of premature ventricular contractions in the early postoperative period.Results The intraoperative cardiopulmonary bypass time was(191.5±50.9)minutes(range:95 to 286 minutes),and the hypothermic ventricular fibrillation time was(99.0±39.8)minutes(range:34 to 203 minutes).The anal temperature before the start of cardiopulmonary bypass was(36.3±0.5)℃(range:35.2 to 38.0℃),the lowest intraoperative anal temperature was(27.3±1.3)℃(range:23.7 to 30.1℃),and the anal temperature at the time of the cessation of cardiopulmonary bypass was(36.3±0.4)℃(range:35.2 to 37.0℃),and excessive rewarming was observed in 33 cases.Six cases applied the artificial heart assist device.Seventeen cases developed premature ventricular contractions in the early postoperative period.Two cases developed neurologic complications.Five cases developed respiratory complications.One case developed urological systemic complications.Six cases were mechanically ventilated for more than 3 days,and the duration of ICU stay in 16 cases wa

关 键 词：心脏瓣膜疾病 胸腔镜检查 二尖瓣 心肺转流术 诱发中度低温 心室颤动 再手术 

分 类 号：R654.2[医药卫生—外科学]