全胸腔镜下心脏不停跳与停跳二尖瓣置换术的对比

doi:10.6040/j.issn.1671-7554.0.2016.351

摘要/Abstract

摘要： 目的探讨全胸腔镜心脏停跳与心脏不停跳心脏外科手术结合的疗效和安全性。方法全胸腔镜下心脏不停跳二尖瓣置换术组(不停跳组,n=19):经股动脉、股静脉插管建立体外循环,在浅低温下阻断主动脉,持续灌注机器氧合血,在心脏空跳下行二尖瓣置换术;全胸腔镜下心脏停跳二尖瓣置换术组(停跳组,n=21):经股动脉、股静脉插管建立体外循环,在中低温下阻断主动脉,灌注心脏停跳液,在心脏停跳下行二尖瓣置换术。结果全部患者均顺利完成手术,术后未出现低心排综合征、严重心律失常、气栓栓塞等严重并发症,无围术期死亡,不停跳组手术时间、主动脉阻断时间较停跳组长(P<0.05); 不停跳组与停跳组相比体外循环时间、ICU监护治疗时间和术后住院时间相对较短,可明显降低住院费用(P<0.05);心肌酶检测显示,两组术前心肌酶肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、心肌肌钙蛋白T(cTnT)差异无统计学意义(P>0.05),在体外循环开始后,两组CK-MB、LDH、cTnT浓度水平均逐渐增高,其中CK-MB与cTnT浓度于术后24 h达到高峰,并开始逐渐下降,LDH浓度呈逐渐上升趋势,两组同时间点相比差异有统计学意义(P<0.05)。结论全胸腔镜心脏不停跳二尖瓣置换术较全胸腔镜心脏停跳二尖瓣置换术术后恢复快,住院费用低,心肌保护效果更好,患者获益大,全胸腔镜心脏外科手术与心脏不停跳心脏外科手术结合具有临床推广应用价值。

关键词: 疗效, 安全性, 全胸腔镜, 心脏不停跳, 二尖瓣置换术, 微创

Abstract: Objective To compare the efficacy and safety of total thoracoscopic cardiac surgery under heart beating and heart arrest. Methods In the heart beating group(n=19), extracorporeal circulation was established through femoral artery and femoral venous cannula. Mitral valve replacement was implemented under the condition of light hypothermal extracorporeal circulation and aortic cross-clamping on heart beating. In the heart arrest group(n=12), extracorporeal circulation was established through femoral artery and femoral venous cannula. Mitral valve replacement was implemented under the condition of middle hypothermal extracorporeal circulation and aortic cross-clamping with cardial arrest. The clinical parameters of the two groups were compared. Results All operations were successful without low cardiac output syndrome, severe arrhythmia, air embolism, perioperative death, and other serious complications. Heart beating group had longer operation time and aorta blocking time than heart arrest group(P<0.05), but shorter in vitro cycle time, ICU monitoring time, and postoperative hospital stay, and lower medical costs(P<0.05). There were no 山东大学学报 (医学版)54卷8期 -刘松涛,等.全胸腔镜下心脏不停跳与停跳二尖瓣置换术的对比 \=-statistical differences in CK-MB, LDH and cTnT before operation between the two groups(P>0.05). After in vitro cycle started, the levels of myocardial enzymes increased; CK-MB and cTnT reached the peak value 24 h after operation and then declined, while LDH showed an uptrend. There were statistical differences between the two groups in the levels of enzymes at the same time points(P<0.05). Conclusion Total thoracoscopic mitral valve replacement under heart beating has advantages of quick recovery, lower hospitalization cost, better myocardial protective effect and more patient benefits compared with total thoracoscopic mitral valve replacement under heart arrest. The combination of the two approaches has wide applicative value in clinical practice.

Key words: Efficacy, Total thoracoscope, Heart beating, Mitral valve replacement, Minimally invasive, Safety

中图分类号:

R654.2

刘松涛,沈斌,林辉,李香伟,温昭科. 全胸腔镜下心脏不停跳与停跳二尖瓣置换术的对比[J]. 山东大学学报（医学版）, 2016, 54(8): 39-43.

LIU Songtao, SHEN Bin, LIN Hui, LI Xiangwei, WEN Zhaoke. A comparative study of total thoracoscopic mitral valve replacement under heart beating and heart arrest[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(8): 39-43.

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