CAJ | 학술논문

目的应用一站式“杂交”手术治疗老年人复杂性心脏病,评价其可行性和安全性.方法 2013年11月至2014年3月共有5例老年复杂性心脏病患者接受一站式“杂交”手术治疗,其中男性4例,女性1例,年龄71 ～78岁,合并COPD 3例,糖尿病2例,高血压3例,心脏瓣膜病变3例,动脉导管未闭1例,冠脉多支病变4例.手术在一站式“杂交”手术室进行,通过右胸小切口施行心脏手术(不停跳前降支旁路移植或瓣膜置换或瓣膜成形),同期对左主干病变和/或其他非前降支病变行经皮冠状动脉介入治或动脉导管(PDA)未闭封堵术.结果 5例患者均顺利进行一站式“杂交手术”,外科手术时间(125±28) min,介入手术时间(65±33) min,体外循环时间(60±23) min,主动脉阻断时间(42±18) min,术后造影桥血管通畅、支架内通畅.术后机械通气时间为(20.5±6.5)h、术后ICU治疗时间为(68.9±16.6)h、术后住院时间为(9.8±3.7)d.术后无严重并发症发生.随访1～5个月,均无胸闷胸痛症状,无出血及栓塞事件,无心血管不良事件发生,心脏超声检查瓣膜情况良好,PDA无再通.瓣膜手术患者抗凝达标.结论一站式“杂交”手术治疗老年人复杂性心脏病能减少手术复杂性,降低手术风险,安全可行.
목적 응용일참식“잡교”수술치료노년인복잡성심장병,평개기가행성화안전성.방법 2013년11월지2014년3월공유5례노년복잡성심장병환자접수일참식“잡교”수술치료,기중남성4례,녀성1례,년령71 ～78세,합병COPD 3례,당뇨병2례,고혈압3례,심장판막병변3례,동맥도관미폐1례,관맥다지병변4례.수술재일참식“잡교”수술실진행,통과우흉소절구시행심장수술(불정도전강지방로이식혹판막치환혹판막성형),동기대좌주간병변화/혹기타비전강지병변행경피관상동맥개입치혹동맥도관(PDA)미폐봉도술.결과 5례환자균순리진행일참식“잡교수술”,외과수술시간(125±28) min,개입수술시간(65±33) min,체외순배시간(60±23) min,주동맥조단시간(42±18) min,술후조영교혈관통창、지가내통창.술후궤계통기시간위(20.5±6.5)h、술후ICU치료시간위(68.9±16.6)h、술후주원시간위(9.8±3.7)d.술후무엄중병발증발생.수방1～5개월,균무흉민흉통증상,무출혈급전새사건,무심혈관불량사건발생,심장초성검사판막정황량호,PDA무재통.판막수술환자항응체표.결론 일참식“잡교”수술치료노년인복잡성심장병능감소수술복잡성,강저수술풍험,안전가행.
Objective To evaluate the efficacy and security of one-stop hybrid cardiac surgery for the treatment of elderly patients with complex heart disease.Methods From November 2013 to March 2014,a total of 5 patients[4 male,age:71-78years] underwent one-stop hybrid approach in the hybrid operating room with chronic obstructive pulmonary disease (COPD) in 3 cases,2 cases of diabetes,3 cases of hypertension,valvular heart disease in 3 cases,PDA in 1 case,4 patients with multivessel coronary disease.Right minimally invasive cardiac surgery(coronary artery bypass grafting or valvular surgery) and percutaneous intervention were performed in an enhanced operative unit.The efficacy and security of one-stop hybrid cardiac surgery were evaluated after the procedure.Results The one-stop hybrid procedure was successful in all patients.Operation time was (125 ± 28) minutes,CPI time was (65 ± 33) minutes,CPB time was (60 ± 23) minutes,Aortic cross clamping time was (42 ± 18) minutes,postoperative mechanical ventilation time was (20.5 ±6.5)hours and ICU monitoring time was (68.9 ± 16.6)hours.Hospitalization time was (9.8 ± 3.7) days.Patients remained free from angina,prosthetic valve dysfunction and patent ductus arteriosus recanalisation(rang 1 to 5 months) follow-up period.Conclusion One-stop hybrid cardiac surgery provides a reasonable,feasible and safe alternative for treating elderly patients with complex heart disease.