达芬奇机器人辅助与常规开胸二尖瓣手术患者术后早期效果的对比观察  

Comparison of early postoperative outcomes between DaVinci robot-assisted and conventional mitral valve surgery

作　　者：张杰 柳国强 宋广辉[3] 刘孝洁[2] 袁莉[2] 刘爱杰[2] Zhang Jie;Liu Guoqiang;Song Guanghui;Liu Xiaojie;Yuan Li;Liu Aijie(Department of Clinical Medicine,Medical Science Center of Qingdao University,Qingdao 266071,China;Department of Anesthesiology,Affiliated Hospital of Qingdao Universitly,Qingdao 266003,China;Department of Clinical laborutory,Affliated Hospital ofQingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学医学部临床医学系,266071 [2]青岛大学附属医院麻醉科,266003 [3]青岛大学附属医院检验科,266003

出　　处：《中国心血管杂志》2024年第3期211-215,共5页Chinese Journal of Cardiovascular Medicine

摘　　要：目的 观察比较达芬奇机器人辅助二尖瓣手术与常规开胸二尖瓣手术患者的短期预后。方法 单中心回顾性临床观察研究。收集2022年4月至2023年4月在青岛大学附属医院行二尖瓣置换或成形手术的174例患者资料,男性81例、女性93例,年龄35~70岁、平均年龄57.9岁,依据手术方式分为达芬奇机器人辅助手术组(达芬奇组,84例)和常规开胸手术组(常规组,90例),比较两组的体外循环时间、主动脉阻断时间和输血量等术中资料,以及术后呼吸机辅助通气时间、重症监护室滞留时间、住院时间、引流量、再次手术、30d内死亡、血常规、C反应蛋白、凝血指标、心肌肌钙蛋白I(cTnI)、血清B型利钠肽(BNP)和肝肾功能等短期预后指标。结果 两组患者术前基线临床资料比较,差异均无统计学意义(均为P>0.05)。两组患者均无术后再次手术及术后30d内死亡情况。与常规组相比,达芬奇组体外循环时间和主动脉阻断时间较长(t=9.420和8.015,均为P<0.001),术中自体血回输量及异体血浆使用量较少(Z=-3.611和-3.332,均为P<0.01),术后呼吸机辅助通气时间、重症监护室滞留时间、住院时间、术后24、48和72h内引流量较少(Z=-5.868、-5.243、-2.989、-7.886、-5.314和-3.222,均为P<0.01),术毕心肌损伤标志物cTnI和BNP水平较低(Z=-5.220和-4.388,均为P<0.001),术毕及术后第1天血小板计数、术毕纤维蛋白原浓度较高(Z=-3.304、-2.521和-3.064,均为P<0.01)。达芬奇组术后3d内肝功能异常发生率较高,差异有统计学意义(χ~2=8.518,P=0.004);但两组术后第5天肝功能异常发生率无统计学差异(χ~2=1.171,P=0.279)。与常规组相比,达芬奇组术后第1和2天的尿素氮水平较低(Z=-3.057和-3.793,均为P<0.01),术后第2天的肌酐水平较低(Z=-2.545,P=0.011)。两组术后C反应蛋白水平比较,差异均无统计学意义(均为P>0.05)。结论 尽管观察到达芬奇机器人辅助较常规开胸二尖瓣手�Objective To compare the short-term outcomes between Da Vinci robot-assisted mitral valve surgery and conventional mitral valve surgery.Methods This was a single-center retrospective clinical observation study.From April 2022 to April 2023,174 patients who underwent mitral valve replacement or repair in the Affiliated Hospital of Qingdao University were enrolled in this study.There were 81 male patients and 93 female patients.The mean age was 57.9 years with a range of 35 to 70 years.The 84 cases received Da Vinci robot-assisted surgery and 90 cases received conventional thoracotomy.The cardiopulmonary bypass time,aortic cross-clamp time,intraoperative blood transfusion volume and other intraoperative data were compared between the two groups.The postoperative ventilation time,length of stay(LOS) in intensive care unit(ICU),LOS in hospital,drainage volume,reoperation rate,30-day mortality,blood routine test,C-reactive protein,blood coagulation test,cardiac troponin I(cTnI),serum brain natriuretic peptide(BNP),liver function,renal function and other short-term prognosis indicators were analyzed.Results No significant differences were found in preoperative baseline data between the two groups(all P>0.05).There was no reoperation ordeath within 30 days after operation in both groups.Compared with the conventional thoracotomy group,the cardiopulmonary bypass time and aortic cross-clamp time were longer in Da Vinci group(t=9.420 and 8.015,both P<0.001),while the amount of autologous blood transfusion and allogeneic plasma dosage were lower in Da Vinci group(Z=-3.611 and-3.332,both P<0.01).The duration of mechanical ventilation,LOS in ICU,LOS in hospital,drainage volume at 24,48 and 72 hours after operation were significantly reduced in Da Vinci group(Z=-5.868,-5.243,-2.989,-7.886,-5.314 and -3.222,all P<0.01).The levels of myocardial injury markers cTnI and BNP were lower-(Z=-5.220 and -4.388,both P<0.001).Platelet count immediately after surgery and on the 1~(st) day after surgery,and fibrinogen concentration immedia

关 键 词：预后 体外循环 达芬奇机器人 开胸术 二尖瓣手术 

分 类 号：R654.2[医药卫生—外科学]