摘要
目的 比较小月龄室间隔缺损患儿经右侧腋下垂直小切口(RVIAT)与胸骨正中切口(MS)入路行室间隔缺损修补术治疗的疗效,探讨其安全性.方法 2020年1月-2022年12月阜外华中心血管病医院行室间隔缺损修补术小月龄(≤3个月)患儿221例,117例采用RVIAT入路者为RVIAT组,104例采用MS入路者为MS组.比较2组性别、日龄、体质量、室间隔缺损直径等临床资料;记录2组手术时间、体外循环时间、主动脉阻断时间、术后机械通气时间、PICU治疗时间、术后24 h出血量、术后24 h撤机率、撤机后二次插管比率及术后心律失常、二次开胸手术情况;比较2组开胸前、术后即刻及2、6 h动态肺顺应性(Cdyn),开胸前、术后即刻及24、48 h氧合指数(OI).结果 (1)2组性别比例、日龄、体质量、室间隔缺损类型、室间隔缺损直径及术前合并肺炎、机械通气比率比较差异均无统计学意义(P＞0.05).(2)2组均一次性手术修补成功.MS组1例因术后出血较多、心包填塞二次开胸,RVIAT组无二次开胸手术病例.MS组术后发生心律失常2例,RVIAT组发生3例,均经补充电解质、应用抗心律失常药物后恢复窦性心律.(3)RVIAT组手术时间[140.00(122.50,170.00)min]、术后机械通气时间[21.00(8.00,63.75)min]、PICU 治疗时间[4(3,6)d]均短于MS 组[175.00(145.00,200.00)min、90.00(48.13,115.88)min、7(5,8)d](P＜0.05),术后 24 h 撤机率(59.83％)高于MS 组(8.65％)(P＜0.05),术后 24 h 出血量[35.0(20.0,52.5)mL]少于 MS 组[40.0(30.0,55.0)mL](P＜0.05),体外循环时间、主动脉阻断时间、术后心律失常发生率及撤机后二次插管比率与MS组比较差异均无统计学意义(P＞0.05).(4)RVIAT 组术后即刻[298.00(164.00,377.00)mmHg]、术后 24 h[348.00(216.00,508.00)mmHg]、术后 48 h[(416.02±160.82)mmHg]OI 均高于 MS 组[220.00(138.75,314.50)、178.00(141.50,234.00)、(273.04± 134.65)mmHg](P＜0.05),开胸前OI与MS组比较差异无统计学意义(P＞0.05);2组开胸前、术后即刻及2、6 h Cdyn比较差异均无统计学意义(P＞0.05).结论 小月龄患儿经RVIAT或MS入路行室间隔缺损修补术均具有较好的疗效和安全性,采用RVIAT入路可缩短手术时间、减少术中出血,促进术后康复,不增加肺损伤发生风险.
Abstract
Objective To compare the efficacies of right vertical infra-axillary thoracotomy(RV1AT)and median sternotomy(MS)on repairing ventricular septal defect(VSD)in infants and to investigate their safeties.Methods In 221 infants(≤3 months)with VSD,117 underwent RVIAT(RVIAT group)and 104 underwent MS(MS group)in Fuwai Central China Cardiovascular Hospital from January 2020 to December 2022.The gender,age,body mass,VSD diameter and other clinical data were compared between two groups.The operative time,cardiopulmonary bypass time,aortic cross-clamp time,postoperative mechanical ventilation time,length of PICU stay,blood loss 24 h after operation,rate of weaning 24 h after operation,rate of re-intubation after weaning,postoperative occurrence of arrhythmia and second heart open operation were recorded.The dynamic compliances before thoracotomy,immediately,2 and 6 h after operation and the oxygenation indexes before thoracotomy,and immediately,24 h and 48 h after operation were compared between two groups.Results(1)There were no significant differences in the gender ratio,day age,body mass,type of VSD,diameter of VSD,preoperative pneumonia,and mechanical ventilation rate between two groups(P＞0.05).(2)All VSDs in two groups were successfully repaired in one operation.One patient in MS group underwent re-thoracotomy due to excessive bleeding and pericardial tamponade,while no patient in RVIAT group underwent re-thoracotomy.Arrhythmia occurred in 2 patients in MS group and 3 patients in RVIAT group after operation,and sinus rhythm was restored after treatment with electrolyte supplementing and antiarrhythmic drugs.(3)The operative time,postoperative mechanical ventilation time and length of postoperative ICU stay were shorter in RVIAT group[140.00(122.50,170.00)min,21.00(8.00,63.75)min,4(3,6)d]than those in MS group[175.00(145.00,200.00)min,90.00(48.13,115.88)min,7(5,8)d](P＜0.05).The rate of weaning 24 h after operation was higher in RVIAT group(59.83％)than that in MS group(8.65％)(P＜0.05).The blood loss 24 h after operation was less in RVIAT group[35.0(20.0,52.5)mL]than that in MS group[40.0(30.0,55.0)mL](P＜0.05).There were no significant differences in the cardiopulmonary bypass time,aortic cross-clamp time,postoperative arrhythmia rate and re-intubation after weaning between two groups(P＞0.05).(4)The oxygenation indexes immediately,24 h and 48 h after operation were higher in RVIAT group[298.00(164.00,377.00),348.00(216.00,508.00),(416.02±160.82)mmHg]than those in MS group[220.00(138.75,314.50),178.00(141.50,234.00),(273.04±134.65)mmHg](P＜0.05),and there was no significant difference in the oxygenation index between two groups before thoracotomy(P＞0.05).The dynamic compliance showed no significant differences before thoracotomy,and immediately,2 h and 6 h after operation between two groups(P＞0.05).Conclusion Both RVIAT and MS can achieve a good efficacy and safety for VSD in low-age infants,and RVIAT can shorten the operative time,reduce intraoperative blood loss,promote the rapid recovery,and increase no risk of lung injury.
基金项目
河南省医学科技攻关计划联合共建项目(LHGJ20210088)
NETL
NSTL
万方数据