右前外胸部小切口手术在心脏多瓣膜病变中的应用效果

Application effect of right anterolateral thoracic small incision surgery in cardiac multi-valvular disease

目的探究右前外胸部小切口手术在心脏多瓣膜病变中的应用效果。方法选取我院2015年7月至2018年6月收治的30例心脏多瓣膜病变患者为研究对象,均采用右前外胸部小切口手术治疗。分析手术治疗情况,比较手术前、后患者血流动力学指标及生活质量评分。结果手术效果理想,围手术期无死亡病例出现,19例行输血治疗,术后发生2例感染(6.67%),经处理后感染消失,无瓣周漏及心动过缓发生。平均体外循环时间(187.42±39.67)min,平均主动脉阻断时间(147.82±36.52)min,平均气管插管时间(23.16±5.43)h,平均监护时间(32.01±3.57)h,平均住院时间(8.06±1.78)d。患者术后和术前心率、舒张压、收缩压、平均动脉压比较,差异无统计学意义(P>0.05);患者术前和术后心率、舒张压、收缩压、平均动脉压均高于术中(P<0.05)。患者术后躯体疼痛、心理功能、日常生活、社会功能评分均高于术前(P<0.05)。结论右前外胸部小切口手术治疗心脏多瓣膜病变效果明显,对患者血流动力学的影响较小,安全性较高,还能提高患者的生活质量,促进患者健康恢复,值得推广应用。

Objective To explore the application effect of right anterolateral thoracic small incision surgery in cardiac multi-valvular disease. Methods A total of 30 patients with cardiac multi-valvular disease admitted in our hospital from July 2015 to June 2018 were selected as research objects. All patients were treated by right anterolateral thoracic small incision surgery. The treatment of operation was analyzed, and the hemodynamic indexes and quality of life scores of patients before and after operation were compared. Results The effect of operation was ideal. There were no deaths during the perioperative period. A total of 19 cases were treated with blood transfusion. Postoperative infection occurred in 2 cases(6.67%) and disappeared after treatment. No perivalvular leakage and bradycardia occurred. The mean cardiopulmonary bypass time was(187.42±39.67) min, the mean aortic blockade time was(147.82±36.52) min, the mean tracheal intubation time was(23.16±5.43) h, the average monitoring time was(32.01±3.57) h, and the average hospitalization time was(8.06±1.78) d. There was no significant difference in the hemodynamic indexes such as heart rate, diastolic blood pressure,systolic blood pressure and mean arterial blood pressure before and after operation(P >0.05). The heart rate, diastolic pressure, systolic pressure and mean arterial pressure before and after operation were higher than those during operation(P<0.05). The scores of physical pain, psychological function, daily life and social function after operation were higher than those before operation(P <0.05). Conclusion The right anterolateral thoracic small incision surgery is effective in the treatment of cardiac multi-valvular lesions. It has less impact on hemodynamics and higher safety. It can also improve the quality of life of patients and promote their health recovery. It is worthy of popularization and application.