右侧腋下小切口入路手术治疗小儿先天性心脏病的临床效果

Clinical effect of right subaxillary small incision approach in thetreatment of children with congenital heart disease

目的探讨右侧腋下小切口入路手术治疗小儿先天性心脏病(CHD)的临床效果。方法选取2018年3月至2022年3月在四平市第一人民医院心胸外科治疗的60例小儿CHD患儿,采用随机数字表法分为观察组和对照组,每组30例。观察组采取经右侧腋下小切口入路手术,对照组采取经胸骨正中切口入路手术。比较两组的各项手术及术后恢复指标、并发症、呼吸功能及疼痛评分。结果两组的手术时间、体外循环时间、主动脉阻断时间比较,差异无统计学意义(P>0.05)。观察组术中出血量、输血量、胸腔引流量等均少于对照组,差异有统计学意义(P<0.05)。观察组感染、肺不张、胸腔积液、低心排的总发生率与对照组比较,差异无统计学意义(P>0.05)。观察组术后1、2、3、4 d的视觉模拟评分低于对照组,差异有统计学意义(P<0.05)。两组各时间点气道峰压比较,差异无统计学意义(P>0.05)。结论右侧腋下小切口入路手术治疗小儿CHD临床效果明显,可减少手术创伤,减轻术后疼痛,避免肺功能损伤。

Objective To investigate the clinical effect of right subaxillary small incision approach in the treatment of children with congenital heart disease(CHD).Methods A total of 60 children with CHD who were treated in the Department of Cardiothoracic Surgery of Siping First People’s Hospital from March 2018 to March 2022 were divided into observation group and control group by random number table method,30 cases in each group.The observation group was operated through the right subaxillary small incision approach,and the control group was operated by transsternal median incision.Indicators related to surgery procedure and postoperative recovery,complications,respiratory function,and pain scores of the two groups were compared.Results The differences of operation time,cardiopulmonary bypass time,and aortic blocking time were not statistically significant between the two groups(P>0.05).The intraoperative bleeding volume,blood transfusion volume and thoracic blood diversion flow in the observation group were less than those in the control group,the differences were statistically significant(P<0.05).The difference of total incidence of complications including infection,atelectasis,pleural effusion,and low cardiac discharge of the two groups was not statistically significant(P>0.05).The visual analogue scale scores of the observation group at 1,2,3 and 4 days after surgery were lower than those of the control group,the differences were statistically significant(P<0.05).The difference of the peak airway pressure of the two groups was not statistically significant(P>0.05).Conclusion The right subaxillary small incision approach has a significant clinical effect on the treatment of children with CHD,which can significantly reduce the surgical trauma,postoperative pain and damage to lung function.