倾向评分法评估Sutureless技术治疗完全性肺静脉异位引流的效果
发布时间：2019-05-24 21:41
【摘要】：【目的】以两种治疗先天性心脏病完全性肺静脉异位引流(TAPVC)不同的手术方法(Sutureless技术和传统方法)为例,应用倾向评分方法评估不同手术方法的优劣。【方法】连续入组2007年10月1日至2013年12月31日本中心所有行外科矫治术的TAPVC婴幼儿179名病例,其中Sutureless组81人,传统手术组98人。病人随访时间为术后1、3、6、12个月。采用三种倾向评分方法(最邻近卡钳法、马氏距离法、成对最佳法)匹配基线因素,匹配变量为:术前肺静脉狭窄(PrePVO)、年龄、性别、体质量、是否新生儿、TAPVC类型。以随机效应脆弱风险模型验证多水平效应,用Kaplan-Meier生存分析与多因素Cox分析方法比较两组手术指标及术后生存率差异。【结果】使用倾向评分中的最邻近卡钳法匹配效果最好。匹配后,Sutureless组中位数体外循环时间87(74.5~103.0)min少于传统手术组99(76.5~123.5)min(P=0.030);Sutureless组中位数主动脉阻断时间43(35~54.5)min少于传统手术组55(40.5~705)min(P0.001);复合事件发生率Sutureless组6.8%(5/73)显著低于传统手术组24.7%(18/73),HR的95%CI=0.20(0.06~0.61),P=0.005。院外死亡发生率Sutureless组1.4%(1/73)低于传统手术组6.8%(5/73),HR的95%CI=0.03(0.01~0.55),P=0.017。两组在术后肺静脉梗阻、围术期死亡率无统计学差异。【结论】使用倾向评分方法评估先天性TAPVC的不同治疗方法的效果显示,使用Sutureless技术能缩短患者术中的主动脉阻断时间与体外循环时间,能降低术后复合事件的发生率及院外死亡率。
[Abstract]:[objective] to take two different surgical methods (Sutureless technique and traditional method) for the treatment of complete abnormal pulmonary venous drainage of congenital heart disease (TAPVC). The propensity score method was used to evaluate the advantages and disadvantages of different surgical methods. [methods] from October 1, 2007 to December 31, 2013, there were 179 TAPVC infants undergoing surgical correction in Japan Center, including 81 infants in Sutureless group and 98 infants in traditional operation group. The follow-up time was 1, 3, 6, 12 months after operation. Three tendency scoring methods (nearest clamp method, Mahalanobis distance method, pairwise optimal method) were used to match the baseline factors. The matching variables were (PrePVO), age, sex, body mass, neonatal type and TAPVC type of pulmonary vein stenosis before operation. The random effect vulnerability risk model is used to verify the multi-level effect. Kaplan-Meier survival analysis and multivariate Cox analysis were used to compare the surgical indexes and postoperative survival rate between the two groups. [results] the nearest clamp method had the best matching effect in the usage tendency score. After matching, the median cardiopulmonary bypass time of 87 (74.5 鈮，
本文编号：2485204
[Abstract]:[objective] to take two different surgical methods (Sutureless technique and traditional method) for the treatment of complete abnormal pulmonary venous drainage of congenital heart disease (TAPVC). The propensity score method was used to evaluate the advantages and disadvantages of different surgical methods. [methods] from October 1, 2007 to December 31, 2013, there were 179 TAPVC infants undergoing surgical correction in Japan Center, including 81 infants in Sutureless group and 98 infants in traditional operation group. The follow-up time was 1, 3, 6, 12 months after operation. Three tendency scoring methods (nearest clamp method, Mahalanobis distance method, pairwise optimal method) were used to match the baseline factors. The matching variables were (PrePVO), age, sex, body mass, neonatal type and TAPVC type of pulmonary vein stenosis before operation. The random effect vulnerability risk model is used to verify the multi-level effect. Kaplan-Meier survival analysis and multivariate Cox analysis were used to compare the surgical indexes and postoperative survival rate between the two groups. [results] the nearest clamp method had the best matching effect in the usage tendency score. After matching, the median cardiopulmonary bypass time of 87 (74.5 鈮，
本文编号：2485204
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