连续梳状肌外半层缝合法缝合右心房切口

Continuous Half-thickness Suture Outside of the Pectinate Muscles in the Right Atrium Incision in Adult Patients Undergoing Cardiac Surgery

目的观察连续梳状肌外半层缝合法缝合右心房切口的效果。方法从2010年1月到2014年6月,选取在我院心脏外科住院手术1 040例经右心房切口的成人心脏手术患者,按入院先后顺序分成两组:对照组,518例,男236例、女282例,平均年龄44.55岁,采用连续全层吻合右心房切口;试验组,522例,男242例、女280,平均年龄45.75岁,采用连续梳状肌外半层吻合右心房切口,观察吻合后右心房切口渗血情况。结果全组患者7例死于术后低心排血量综合征,其中对照组4例,试验组3例。对照组有203例患者术中检查发现右心房吻合口渗血,需要局部再次缝合止血,有3例患者二次开胸后发现右心房吻合口出血;试验组有26例患者需要局部再次缝合止血(P<0.001),无一例患者因右心房吻合口出血而再次开胸。结论连续梳状肌外半层缝合右心房切口能更好地预防右心房吻合口出血。

Objective To evaluate the continuous half-thickness suture outside of the pectinate muscles in the right atrium incision in adult patients undergoing cardiac surgery.Methods A total of 1 040 consecutive adult patients undergoing cardiac surgery by the right atrium incision with cardiopulmonary bypass(CPB) were randomly divided into a control group(n=518 with 236 males and 282 females at mean age of 44.55 years) and a trial group(n=522 with242 males and 280 females at mean age 45.75 years) between January 2010 and June 2014.The right atrium incision was sutured by continuous full-thickness suture in the control group and sutured by continuous half-thickness suture in the trial group.After the suture,the bleeding in the right atrium incision was recorded.Results All patients underwent the open-heart operation.Seven patients died of postoperative low cardiac syndrome including four patients in the control group and 3 patients in the trial group.The heart incision was inspected before suturing the pericardium.A total of 203 patients of local active bleeding were stitched again in the right atrium incision in the control group.Only 26 patients were stitched again in the trial group(P<0.001).In the cases of re-exploration for bleeding or tamponade after cardiac operation,3 patients of bleeding due to the right atrium incision were confirmed in the control group,and no one was confirmed in the trial group.Conclusion The continuous half-thickness suture in the right atrium incision can prevent the incision bleeding,and avoid locally stitching again in adult patients undergoing cardiac surgery.