微创、正中切口在间隔缺损修补中的血液保护对比研究

目的近年,尽管许多血液保护技术及药物应用于心脏外科手术,失血和输血却总是依然存在。我们假设微创切口能够减少青春期间隔缺损患者术后失血和输血。方法回顾性的分析了连续的、接受先天性房间隔缺损修补或室间隔缺损修补的42名青春期患者,27例胸部正中切口,15例胸部前外侧切口,即右侧腋下胸部小切口(经肋间隙)。为了评估微创切口对于减少失血及输血的功效,就手术时间、术后总引流量及输血几率等做了对比。结果15例胸部前外侧切口中有2例输血,27例胸部正中切口中有13例输血(P<0.05)。胸部前外侧切口术后引流量(215.93±188.62)ml,低于胸部正中切口(471.85±423.14)ml(P<0.05)。胸部前外侧切口术后引流管拔除时间(27.20±6.18)h,低于胸部正中切口(35.96±14.58)h(P<0.05)。结论微创切口能够明显地减少青春期先天性间隔缺损修补术病人的失血和输血。

Study of blood conservation function of minimally invasive approach versus median sternotomy approach for repair of congenital atrial defect/ventricular defect

Objective Despite the recent introduction of a number of technical and pharmacologic blood conservation measures,bleeding and blood transfusion remain persistent problems in open heart surgical procedures.We hypothesized that a minimally invasive approach would provide a safe reduction in postoperative bleeding and allogeneic blood transfusion for repair of congenital ventricular defect repair or congenital ventricular defect in pubescent patients.Methods Forty-two consecutive pubescent patients underwent repair of congenital ventricular defect repair or congenital ventricular defect were retrospectively enrolled in this study,27 done through median sternotomy approach,15 done through thoracic anterolateral incision,namely,right minimal subaxillary thoracotomy incision(by intercostel space).To evaluate the relative efficacy of minimally invasive approach in postoperative bleeding and allogeneic blood transfusion,comparisons were made between mean operation time,mean postoperative chest tube drainage volume,rate of allogeneic blood transfusion,etc.Results Two of the fifteen pubescent patients done through thoracic anterolateral incision(TAI) were transfused,while thirteen of the twenty-seven done through median sternotomy approach(MSA) were transfused(P<0.05).The postoperative chest tube drainage volume of the TAI was less than that of the MSA,it was(215.93±188.62)ml versus(471.85±423.14)ml(P<0.05).The time of postoperative chest tube remove of the TAI was less than that of the MSA,it was(27.20±6.18)h versus(35.96±14.58)h(P<0.05)Conclusion A minimally invasive approach can significantly decrease bleeding and need of allogeneic transfusion in repair of congenital ventricular defect repair or congenital ventricular defect in pubescent patients.