机器人辅助下二尖瓣置换术学习曲线临界值的确定及意义  

Determination and significance of the learning curve threshold for robot-assisted mitral valve replacement

作　　者：栾同晓 聂卫红 王荣梅 张宏[1] 吴玉辉[1] 杨苏民[1] LUAN Tongxiao;NIE Weihong;WANG Rongmei;ZHANG Hong;WU Yuhui;YANG Sumin(Department of Cardiovascular Surgery,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院心血管外科,山东青岛266003

出　　处：《精准医学杂志》2024年第5期435-438,443,共5页Journal of Precision Medicine

基　　金：国家自然科学基金青年科学基金项目(81700247)。

摘　　要：目的明确机器人辅助下二尖瓣置换术的学习曲线的临界值,为临床工作提供指导。方法回顾性分析2014年12月—2017年12月37例在我院心血管外科完成的机器人辅助下二尖瓣置换术患者的临床资料,根据手术日期排序,计算手术时间、转机时间及阻断时间的累积和(CUSUM)值,绘制曲线并拟合,以手术时间的最高CUSUM值为分界点将患者进行分组,比较两组患者一般资料、手术时间、转机时间、阻断时间、手术前3 d的总引流量(心包胸骨后及胸腔引流量之和)、住院时间、围术期药物及血制品使用情况、是否行二次开胸手术等方面的差异。结果跨越机器人辅助下二尖瓣置换术手术时间学习曲线的最低例数为9例,跨越转机时间、阻断时间的最低例数分别为12、11例。以第9例为界进行分组,两组在术后第2、3天总引流量及术后红细胞、血浆用量的差异有显著性(Z=2.21~2.55,P<0.05)。结论机器人辅助下二尖瓣置换术从学习阶段进入熟练阶段需要累积的最低手术例数为9例,学习阶段应密切关注患者病情的变化,积极改善预后。Objective To investigate the learning curve threshold for robot-assisted mitral valve replacement,and to provide guidance for clinical practice.Methods A retrospective analysis was performed for the clinical data of 37 patients who underwent robot-assisted mitral valve replacement in Department of Cardiovascular Surgery in our hospital from December 2014 to December 2017,and the patients were ordered based on date of surgery.The cumulative sum(CUSUM)was calculated for time of operation,duration of cardiopulmonary bypass(CPB),and aortic cross-clamp time,and the CUSUM learning curve was modeled by curve fitting.The patients were divided into two groups based on the highest CUSUM of time of operation,and the two groups were compared in terms of general information,time of operation,duration of CPB,aortic cross-clamp time,total drainage volume(the sum of retrosternal drainage volume and thoracic drainage volume)during the 3 days before surgery,length of hospital stay,use of drugs and blood products in the perioperative period,and whether secondary thoracotomy was performed.Results The fitting curve reached the top at the 9th case on the time of operation,and the highest numbers of CPB and aortic cross-clamp time were 12 and 11,respectively.The patients were divided into two groups at the 9th case,and there were significant differences between the two groups in total drainage volume and the amount of red blood cell and plasma used after surgery on days 2 and 3(Z=2.21-2.55,P<0.05).Conclusion The minimum number of cases is 9 for robot-assisted mitral valve replacement to develop from the learning stage to the proficiency stage.Changes in patient conditions should be closely monitored during the learning stage to actively improve their prognosis.

关 键 词：机器人手术 心脏瓣膜假体植入 二尖瓣成形术 学习曲线 时间因素 预后 

分 类 号：R654.2[医药卫生—外科学] R319.1[医药卫生—临床医学]