经右侧腋下垂直小切口治疗婴儿室间隔缺损近期疗效观察  

Short-term efficacy of right vertical infra-axillary thoracotomy on repairing ventricular septal defect in infants

作　　者：梁维杰[1] 华影 张合琪 李斌[1] 王露露 董好举[1] 范太兵[1] LIANG Weijie;HUA Ying;ZHANG Heqi;LI Bin;WANG Luu;DONG Haoju;FAN Taibing(Children Heart Center,Henan Provincial People's Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou,Henan451464,China)

机构地区：[1]河南省人民医院阜外华中心血管病医院儿童心脏中心,河南郑州451464

出　　处：《中华实用诊断与治疗杂志》2024年第5期474-477,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210088)。

摘　　要：目的 比较小月龄室间隔缺损患儿经右侧腋下垂直小切口(RVIAT)与胸骨正中切口(MS)入路行室间隔缺损修补术治疗的疗效,探讨其安全性。方法 2020年1月-2022年12月阜外华中心血管病医院行室间隔缺损修补术小月龄(≤3个月)患儿221例,117例采用RVIAT入路者为RVIAT组,104例采用MS入路者为MS组。比较2组性别、日龄、体质量、室间隔缺损直径等临床资料;记录2组手术时间、体外循环时间、主动脉阻断时间、术后机械通气时间、PICU治疗时间、术后24 h出血量、术后24 h撤机率、撤机后二次插管比率及术后心律失常、二次开胸手术情况;比较2组开胸前、术后即刻及2、6 h动态肺顺应性(Cdyn),开胸前、术后即刻及24、48 h氧合指数(OI)。结果 (1)2组性别比例、日龄、体质量、室间隔缺损类型、室间隔缺损直径及术前合并肺炎、机械通气比率比较差异均无统计学意义(P>0.05)。(2)2组均一次性手术修补成功。MS组1例因术后出血较多、心包填塞二次开胸,RVIAT组无二次开胸手术病例。MS组术后发生心律失常2例,RVIAT组发生3例,均经补充电解质、应用抗心律失常药物后恢复窦性心律。(3)RVIAT组手术时间[140.00(122.50,170.00)min]、术后机械通气时间[21.00(8.00,63.75)min]、PICU治疗时间[4(3,6)d]均短于MS组[175.00(145.00,200.00)min、90.00(48.13,115.88)min、7(5,8)d](P<0.05),术后24 h撤机率(59.83%)高于MS组(8.65%)(P<0.05),术后24 h出血量[35.0(20.0,52.5)mL]少于MS组[40.0(30.0,55.0)mL](P<0.05),体外循环时间、主动脉阻断时间、术后心律失常发生率及撤机后二次插管比率与MS组比较差异均无统计学意义(P>0.05)。(4)RVIAT组术后即刻[298.00(164.00,377.00)mmHg]、术后24 h[348.00(216.00,508.00)mmHg]、术后48 h[(416.02±160.82)mmHg]OI均高于MS组[220.00(138.75,314.50)、178.00(141.50,234.00)、(273.04±134.65)mmHg](P<0.05),开胸前OI与MS组比较差异无统计学意义(P>0.05);2组开胸前、术后�Objective To compare the efficacies of right vertical infra-axillary thoracotomy(RVIAT)and median sternotomy(MS)on repairing ventricular septal defect(VSD)in infants and to investigate their safeties.Methods In 221 infants(<3 months)with VSD,117 underwent RVIAT(RVIAT group)and 104 underwent MS(MS group)in Fuwai Central China Cardiovascular Hospital from January 2020 to December 2022.The gender,age,body mass,VSD diameter and other clinical data were compared between two groups.The operative time,cardiopulmonary bypass time,aortic cross-clamp time,postoperative mechanical ventilation time,length of PICU stay,blood loss 24 h after operation,rate of weaning 24 h after operation,rate of re-intubation after weaning,postoperative occurrence of arrhythmia and second heart open operation were recorded.The dynamic compliances before thoracotomy,immediately,2 and 6 h after operation and the oxygenation indexes before thoracotomy,and immediately,24 h and 48 h after operation were compared between two groups.Results(1)There were no significant differences in the gender ratio,day age,body mass,type of VSD,diameter of VSD,preoperative pneumonia,and mechanical ventilation rate between two groups(P>0.05).(2)All VSDs in two groups were successfully repaired in one operation.One patient in MS group underwent re-thoracotomy due to excessive bleeding and pericardial tamponade,while no patient in RVIAT group underwent re-thoracotomy.Arrhythmia occurred in 2 patients in MS group and 3 patients in RVIAT group after operation,and sinus rhythm was restored after treatment with electrolyte supplementing and antiarrhythmic drugs.(3)The operative time,postoperative mechanical ventilation time and length of postoperative ICU stay were shorter in RVIAT group[140.00(122.50,170.00)min,21.00(8.00,63.75)min,4(3,6)d] than those in MS group[175.00(145.00,200.00)min,90.00(48.13,115.88)min,7(5,8)d](P<0.05).The rate of weaning 24 h after operation was higher in RVIAT group(59.83%)than that in MS group(8.65%)(P<0.05).The blood loss 24 h after operation

关 键 词：室间隔缺损 右侧腋下垂直小切口 胸骨正中切口 肺损伤 

分 类 号：R726.5[医药卫生—儿科]