不同时间段手术对二尖瓣手术风险的影响

Effect of different time periods of surgery on the risk of mitral valve surgery

目的:评价上午、下午、晚间不同时间段手术对二尖瓣手术患者围术期风险的影响。方法:2018年1月至2020年12月,安贞医院心脏外科收治的947例二尖瓣手术患者,根据手术开始时间分为三组:上午手术组(手术开始时间8:00~10:30,n=231)、下午手术组(手术开始时间12:00~14:30,n=543)、晚间手术组(手术开始时间17:30~20:00,n=173)。对比三组患者术后住院死亡率及不良事件风险。结果:三组患者术后住院死亡率分别为0.9%、1.5%、1.2%,差异无统计学意义(P=0.768)。体外循环时间、主动脉阻断时间、二尖瓣成形失败转换瓣、主动脉阻断≥2次、术后呼吸机辅助时间、重症监护病房滞留时间、术后住院脑血管事件、住院期间非计划二次手术、主动脉内球囊反搏、体外膜肺氧合、连续性肾脏替代治疗等方面,差异均无统计学意义(P>0.05)。结论:上午、下午和晚间不同时间段进行二尖瓣手术术后早期死亡和不良事件的风险是无统计学差异的。晚间行二尖瓣手术是安全的。

Objective:To investigate the effect of different time periods of surgery in the morning,afternoon and evening on the risk of surgical mitral valve surgery.Methods:From January 2018 to December 2020,947 patients with mitral valve surgery in Beijing Anzhen Hospital were selected.These patients were divided into 3 groups according to the starting time of surgery.Morning group(operation start time 8:00-10:30,n=231),afternoon group(operation start time 12:00-14:30,n=543),and evening group(operation start time 17:30-20:00,n=173).The mortality and adverse events of the three groups were compared.Results:The in-hospital mortality of the three groups were 0.9%,1.5%and 1.2%,respectively(P=0.768).There were no significant difference in duration of cardiopulmonary bypass and cross clamp time,mitral valve repair switch to mitral valve replacement,number of aortic cross-clamping greater than or equal to 2 times,ventilation time,length of stay in intensive care unit,post-operative cerebrovascular event,unplanned secondary operation during hospitalization,intra-aortic balloon pump,extracorporeal membrane oxygenation,continuous renal replacement therapy,all P>0.05.Conclusions:There was no significant difference in the risk of early death and adverse events in patients underwent mitral valve surgery in the morning,afternoon and evening.Mitral valve surgery at night is safe.