目的 探讨全胸腔镜微创手术在体外循环心脏瓣膜术中的应用效果.方法 选取2022年4月至2023年4月惠州市中心人民医院和高州市人民医院接受体外循环心脏瓣膜手术的60例患者作为研究对象,按照随机数字表法分为A组(30)、B组(30例).A组行全胸腔镜微创心脏手术,B组行传统正中开胸心脏手术.比较两组相关手术指标、术后疼痛评分、并发症发生情况及手术前后应激反应指标变化情况.结果 A组手术时间、体外循环时间、主动脉阻断时间长于B组,术中出血量、输血量少于B组,差异有统计学意义(P＜0.05).A组术后引流量少于B组,术后呼吸机使用时间、ICU停留时间短于B组,差异有统计学意义(P＜0.05);A组术后第1天、术后第三日伤口疼痛评分低于B组,差异有统计学意义(P＜0.05);A组术后并发症总发生率低于B组,差异有统计学意义(P＜0.05).两组术前身体应激反应指标比较,差异无统计学意义(P＞0.05),两组术后72 h的肾上腺素、去甲肾上腺素、皮质醇水平均高于术前,但A组的肾上腺素、去甲肾上腺素、皮质醇水平低于B组,差异有统计学意义(P＜0.05).结论 比较正中开胸心脏手术,全胸腔镜微创体外循环心脏瓣膜手术术中出血量、输血量低、术后恢复快、术后并发症少等优势.
Objective To analyze the application effect of total thoracoscopy minimally invasive cardiac surgery.Methods From April 2022 to April 2023,60 patients of undergoing the cardiopulmonary bypass cardiac valve surgery in Huizhou Municipal Central Hospital and the People's Hospital of Gaozhou were chosen as the study subjects,according to the random number table method,they were divided into group A(30)and group B(30 cases).Group A received total thoracoscopy min-imally invasive heart surgery,and group B received traditional median thoracotomy.The relevant surgical indicators,postoperative pain scores,and incidence of complications between two groups were compared.Results The surgical time,extracorporeal circulation time,and aortic occlusion time in group A were longer than those in group B,while the blood loss and transfusion volume were lower than those in group B,with statistically significant differences(P＜0.05).The postopera-tive drainage volume in group A was lower than that in group B,and the postoperative ventilator use time and ICU stay time were shorter than those in group B,with statistically significant differences(P＜0.05).The wound pain score on the first and third postoperative days in group A was lower than those in group B,with statistically significant difference(P＜0.05).The total incidence of postoperative complications in group A was lower than that in group B,with a statistically significant difference(P＜0.05).There were no statistically significant differences in the comparison of physical stress response indi-cators between the groups before operation(P＞0.05).The levels of adrenaline,norepinephrine and cortisol of the two groups 72 hours after operation were higher than before operation,and the norepinephrine and cortisol in the group A were lower than those in the group B,with statistically significant differences(P＜0.05).Conclusion Compared with median open heart surgery,total thoracoscopy minimally invasive cardiopulmonary bypass heart valve surgery has the advantages of low trauma,rapid postoperative recovery,and fewer postoperative complications.
许发珍;陈凯明;朱铭;苏少萍
广东省惠州市中心人民医院心脏大血管外科,广东惠州 516000广东省高州市人民医院心血管外科,广东高州 525200
临床医学
全胸腔镜微创心脏手术;正中开胸手术;并发症;体外循环心脏瓣膜手术
Total thoracoscopic cardiac surgery;Median stemotomy;Complications;Cardiopulmonary bypass
《中国当代医药》 2024 (001)
39-42,46 / 5
广东省惠州市医疗领域科技计划项目(2022CZ010085).
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