摘要
目的分析右侧腋下小切口心脏停跳与不停跳下单纯性房间隔缺损修补术的临床效果。方法 2009年9月至2011年8月,第三军医大学大坪医院野战外科研究所施行右侧腋下小切口单纯性房间隔缺损修补术45例。包括心脏不停跳组22例,其中男13例、女9例,年龄(3.2±2.1)岁,体重(13.1±4.0)kg,房间隔缺损中央型20例,下腔型2例,平均房间隔缺损直径(12.2±5.1)mm;心脏停跳组23例,其中男14例、女9例,年龄(3.5±2.5)岁,体重(12.9±3.3)kg,房间隔缺损中央型18例,上腔静脉窦型3例,下腔型2例,平均房间隔缺损直径(11.6±4.7)mm。测定患者术前、停机时、术后6 h和术后24 h外周静脉血肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、天门冬氨酸氨基转移酶(AST)和心肌肌钙蛋白I(c Tn I)含量。结果全组无术中死亡病例。术后发生右肺不张1例,右侧气胸1例。心脏不停跳组体外循环时间和手术时间均短于心脏停跳组(P<0.05),但两组病例在术中输血量、呼吸机辅助通气时间、住ICU时间、术后住院时间、术后24 h胸腔引流量以及术后心功能等方面差异无统计学意义(P>0.05)。两组术前CK、CK-MB、AST和c Tn I均在正常范围且差异无统计学意义(P>0.05),但体外循环术后均不同程度升高,心脏停跳组上升更快(P<0.05);心脏不停跳组术后CK、CK-MB、AST和c Tn I均低于心脏停跳组(P<0.05)。结论对于单纯性房间隔缺损病例,右侧腋下小切口心脏不停跳房间隔缺损修补术是一种安全可靠、切口美观、手术时间短且心肌损伤程度较轻的手术方式。
Objective To investigate clinical outcomes of isolated atrial septal defect(ASD) repair on the beating or non-beating heart through minimally invasive right axillary approach. Methods Forty-five patients underwent isolated ASD repair through minimally invasive right axillary approach in Research Institute of Surgery,Daping Hospital of the Third Military Medical University from September 2009 to August 2011. According to different surgical techniques,all the patients were divided into a beating-heart group and a non-beating heart group. In the beating-heart group,there were 22 patients including 13 males and 9 females with their mean age of 3.2±2.1 years and body weight of 13.1±4.0 kg. There were 20 patients with ostium secundum ASD and 2 patients with ostium primum ASD. Mean ASD diameter in the beating-heart group was 12.2±5.1 mm. In the non-beating heart group,there were 23 patients including 14 males and 9 females with their mean age of 3.5±2.5 years and body weight of 12.9±3.3 kg. There were 18 patients with ostium secundum ASD,3 patients with sinus venosus ASD,and 2 patients with ostium primum ASD. Mean ASD diameter in the non-beating heart group was 11.6±4.7 mm. Serum creatine kinase(CK),creatine kinase isoenzyme(CK-MB),aspartate aminotransferase(AST) and highly sensitive cardiac troponin I(c Tn I) were examined preoperatively,after weaning from cardiopulmonary bypass(CPB),6 hours and 24 hours postoperatively. Results There was no in-hospital death. Postoperatively,1 patient had right atelectasis and another patient had right pneumothorax. CPB time and operation time of the beating-heart group were significantly shorter than those of the non-beating heart group(P < 0.05). There was no statistical difference in intraoperative blood transfusion,mechanical ventilation time,length of postoperative ICU stay or hospital stay,chest drainage within 24 hours postoperatively,or postoperative cardiac function between the 2 groups(P > 0.05). Preoperative levels of CK,CK-MB,AST and c Tn I were all within the normal limit,and there was no statistical difference between the 2 groups(P > 0.05). After CPB,CK,CK-MB,AST and c Tn I levels increased in both groups,but increased significantly greater in the non-beating heart group(P < 0.05). Postoperative levels of CK,CK-MB,AST and c Tn I of the beating-heart group were significantly lower than those of the non-beating heart group(P < 0.05). Conclusion Isolated ASD repair on the beating heart via minimally invasive right axillary approach is a safe and cosmetic procedure with shorter operation time and less myocardial injury.
出处
《中国胸心血管外科临床杂志》
CAS
2014年第6期783-787,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
心脏不停跳
微创手术
房间隔缺损
Beating-heart surgery
Minimally invasive surgery
Atrial septal defect
