背景:术后拔管时间在心脏瓣膜手术后的预后中起作用;然而,其确切影响尚未得到澄清。这项研究比较了微创手术和传统胸骨切开术的术后结果,重点关注早期拔管和影响长期机械通气的因素。
方法:对2019年8月至2022年6月在浙江省人民医院行心脏瓣膜手术的744例患者资料进行回顾性分析。使用逆概率加权(IPTW)和Kaplan-Meier曲线比较了接受常规正中胸骨切开术(MS)和微创(MI)电视胸腔镜手术的患者的结局。临床数据,包括手术数据,术后心功能,术后并发症,和重症监护监测数据,进行了分析。
结果:在倾向评分匹配和IPTW之后,将196例常规MS与196例MI胸腔镜手术进行比较。与常规MS组患者相比,匹配队列中MI胸腔镜手术组术后早期拔管率较高(P<0.01),降低术后胸腔积液发生率(P<0.05),在重症监护病房的住院时间明显缩短(P<0.01),住院总时间缩短(P<0.01),住院总费用较低(P<0.01)。
结论:成功的早期气管拔管对于心脏瓣膜手术后患者的重症监护管理很重要。与传统MS相比,MI电视辅助胸腔镜手术的优势包括显着减少使用机械通气支持的持续时间,缩短了重症监护病房的住院时间,缩短了总住院时间,和良好的患者康复率。
BACKGROUND: Postoperative time to extubation plays a role in prognosis after heart valve surgery; however, its exact impact has not been clarified. This study compared the postoperative outcomes of minimally invasive surgery and conventional
sternotomy, focusing on early extubation and factors influencing prolonged mechanical ventilation.
METHODS: Data from 744 patients who underwent heart valve surgery at the Zhejiang Provincial People\'s Hospital between August 2019 and June 2022 were retrospectively analyzed. The outcomes in patients who underwent conventional median
sternotomy (MS) and minimally invasive (MI) video-assisted thoracoscopic surgery were compared using inverse probability of treatment weighting (IPTW) and Kaplan-Meier curves. Clinical data, including surgical data, postoperative cardiac function, postoperative complications, and intensive care monitoring data, were analyzed.
RESULTS: After propensity score matching and IPTW, 196 cases of conventional MS were compared with 196 cases of MI video-assisted thoracoscopic surgery. Compared to patients in the conventional MS group, those in the MI video-assisted thoracoscopic surgery group in the matched cohort had a higher early postoperative extubation rate (P < 0.01), reduced incidence of postoperative pleural effusion (P < 0.05), significantly shorter length of stay in the intensive care unit (P < 0.01), shorter overall length of hospital stay (P < 0.01), and lower total cost of hospitalization (P < 0.01).
CONCLUSIONS: Successful early tracheal extubation is important for the intensive care management of patients after heart valve surgery. The advantages of MI video-assisted thoracoscopic surgery over conventional MS include significant reductions in the duration of use of mechanical ventilation support, reduced length of intensive care unit stay, reduced total length of hospitalization, and a favorable patient recovery rate.