微创直视主动脉瓣置换术在主动脉瓣病变患者中的临床应用

发布时间：2018-03-26 03:37

  本文选题：主动脉瓣置换术　切入点：微创　出处：《中国现代医学杂志》2017年05期

【摘要】：目的总结经右侧胸骨旁纵行小切口行微创直视主动脉瓣置换术的临床经验,并评价其安全性和疗效。方法 2014年12月-2016年3月,8例主动脉瓣病变患者接受了微创直视主动脉瓣置换术。男5例,女3例,年龄(45.12±9.09)岁。患者采用全身麻醉双腔气管插管,颈内静脉及股动、静脉插管建立体外循环右侧胸骨旁第2~3肋间隙纵行小切口(4~6 cm)进胸,直视下完成主动脉瓣置换术。结果全组无中转前正中开胸,无死亡,均痊愈出院。患者体外循环时间(102.87±29.88)min,主动脉阻断(69.00±20.98)min,手术时间(248.12±69.69)min,术后呼吸机辅助(10.42±3.08)h,术后重症监护病房(ICU)停留(17.56±3.19)h,术后住院(8.00±2.87)d。术中失血量(212.50±84.64)ml,术后24h胸腔引流量(195.46±60.38)ml,胸腔引流管留置时间(2.32±0.55)d;4例患者未输血,平均输血量(218.75±247.76)ml。切口平均长度(4.92±0.88)cm。出院前复查无瓣周漏及人工瓣膜功能障碍。8例随访(11.50±4.37)个月无死亡,心功能恢复至Ⅰ级,人工瓣膜未见异常。结论部分主动脉瓣病变患者采用外周血管插管建立体外循环,经右侧胸骨旁纵行小切口完成微创直视主动脉瓣置换术创伤小,出血和输血少并发症少术后恢复快,安全可靠,效果确切,值得临床推广。
[Abstract]:Objective to summarize the clinical experience of minimally invasive direct vision aortic valve replacement through the right parasternal longitudinal small incision. Methods from December 2014 to March 2016, 8 patients with aortic valve disease underwent minimally invasive direct aortic valve replacement. There were 5 males and 3 females, aged 45.12 卤9.09 years. Internal jugular vein, femoral artery and vein intubate to establish the right parasternal third costal space longitudinal incision of 4 ~ 6 cm) into the chest and complete aortic valve replacement under direct vision. Results there was no central thoracotomy and no death. The time of CPB was 102.87 卤29.88 min, aortic occlusion was 69.00 卤20.98 min, operative time was 248.12 卤69.69 min, postoperative ventilator was 10.42 卤3.08 min, ICU) stayed 17.56 卤3.19 h, hospitalization was 8.00 卤2.87 d, blood loss volume was 212.50 卤84.64ml, thoracic drainage was 195.46 卤60.38ml. The retention time of tube was 2.32 卤0.55 days and 4 patients did not receive blood transfusion. The mean volume of blood transfusion was 218.75 卤247.76 ml. The average incision length was 4.92 卤0.88 cm 路cm. There was no death and cardiac function recovered to grade 鈪，

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