体重对小儿全胸腔镜心脏手术的影响

The influence of body weight on total thoracoscopic cardiac surgery in children

目的研究体重对小儿全胸腔镜心脏手术的影响及小儿全胸腔镜心脏手术的安全性。方法选取体重20kg以下(A组)、20～30kg(B组)、30kg以上(C组)行全胸腔镜心脏手术的患儿各20例,比较各组住院相关时间、血常规主要指标变化以及出血和输血量。结果所有手术均获得成功。A组术后发生肺炎1例;B组术后发生脑缺血1例;C组因术后胸腔引流量大,二次开胸止血1例;经治疗后均痊愈,无术后死亡病例。三组患儿住院时间无显著性差异(P>0.05)。与A组相比,B、C两组主动脉阻闭时间、呼吸机辅助呼吸时间以及ICU滞留时间较短(P<0.05),胸腔引流量、输血浆量较多(P<0.05),手术前后血红蛋白、白细胞以及血小板变化较小(P<0.05)。B组与C组主动脉阻闭时间、呼吸机辅助呼吸时间以及ICU滞留时间无显著性差异(P>0.05)。结论小儿全胸腔镜下心脏手术是安全有效的。其中体重20kg以上的患儿对手术耐受能力较强,术后早期恢复快,更适合在全胸腔镜下行心脏手术。

Objective To study the relationship and safety of total thoracoscopic surgery （TTS） in treating cardiac disease in children with different body weight. Methods Pediatric patients weighing less than 20kg, 20--30kg and exceeding 30kg undergoing TTS were grouped as A, B and C respectively, with 20 patients in each group. The clinical records of the three groups were compared at hospitaliza tion, data of blood routine tests, blood loss and volume of transfusion during operation were analyzed. Results All operations were suc cessfully performed. One patient in group A had a complication of pneumonia after the operatiorL In another patient in group B cerebral is chemia occurred. One patient in group C underwent secondary thoracotomy for haemostasis because of excessive postoperative chest drain age. All patients made a full recovery with no postoperative death. No significant difference existed on the length of hospital stay among the three groups of patients （P〉0.05）. Compared with group A, the aortic occlusion time, ventilation time and the length of stay in ICU were shorter in groups B and C （P〈0.05）. In group A, the amount of blood transfusion and blood loss were less than that in groups B and C （P〈0. 05）. The changes in blood counts were less evident in group B and C than that in group A. No statistically significant differences （P〉0.05） were found between group B and C in the aortic occlusion time, ventilation time and length of stay in ICU. Conclusion TTS is a safe and reliable surgical madality for the treatment of pediatric cardiac diseases. Patients weighed over 20kg are strong enough to withstand TTS and may recover sooner.