Grossi E A, Zakow P K, Ribakove G, Kallenbach K, Ursomanno P, Gradek C E, Baumann F G, Colvin S B, Galloway A C
Department of Surgery, New York University School of Medicine, NY, USA.
Eur J Cardiothorac Surg. 1999 Nov;16 Suppl 2:S39-42.
Although it has been postulated that minimally invasive cardiac surgery using the port access method would reduce operative stress and postoperative pain and accelerate postoperative recovery to a good quality of life, few data are currently available to document this intuitively appealing claim. Therefore, this study was designed to examine differences in stress response, postoperative pain, rapidity of recovery, and quality of life after port access (PA) isolated coronary artery bypass surgery compared with standard sternotomy (STD) isolated coronary bypass surgery.
Fourteen PA and 15 STD coronary bypass patients were studied postoperatively for pain score, FEV, catecholamine and cortisol levels, resumption of activity, and Duke Activity Scale ratings. The surgical approach was based on the surgeon's preference. Although the PA patients were younger, there were no other differences between the groups in gender or preoperative risk factors.
There were no operative deaths and no differences between the groups in perioperative complications. Repeated measures analysis of variance showed lower pain scale ratings over the first 4 postoperative weeks in the PA group (P < 0.001). The PA patients also had less muscle soreness, shortness of breath, fatigue, and poor appetite at 1, 2, 4, and 8 weeks (P < 0.05), better FEV at 1 day (1.59 vs. 0.97 l/s; P < 0.02) and 3 days (2.20 vs. 1.49 l/s; P < 0.03), and lower norepinephrine levels at days 1, 2, and 3 (P = 0.005). The Duke Activity Scale questionnaire results demonstrated that more PA patients were able to walk 1-2 blocks at 1 week, climb stairs at 1 and 2 weeks, perform light or moderate housework at 1 and 2 weeks, and engage in moderate recreational activities and perform heavy housework at 4 and 8 weeks (P < 0.05).
These results show that compared with STD coronary bypass patients PA patients enjoyed significant postoperative physiologic and quality of life advantages with less pain, less early stress response, better pulmonary function, and superior Duke Activity scores during the first 2 postoperative months.
尽管有人推测采用端口入路法的微创心脏手术会减轻手术应激和术后疼痛，并加速术后恢复至良好的生活质量，但目前几乎没有数据能证明这一颇具吸引力的观点。因此，本研究旨在比较端口入路（PA）孤立冠状动脉搭桥手术与标准胸骨切开术（STD）孤立冠状动脉搭桥手术后的应激反应、术后疼痛、恢复速度和生活质量的差异。
对14例PA冠状动脉搭桥患者和15例STD冠状动脉搭桥患者术后的疼痛评分、第一秒用力呼气量（FEV）、儿茶酚胺和皮质醇水平、活动恢复情况以及杜克活动量表评分进行了研究。手术方式基于外科医生的偏好。尽管PA组患者更年轻，但两组在性别或术前危险因素方面没有其他差异。
两组均无手术死亡，围手术期并发症也无差异。重复测量方差分析显示，PA组术后前4周的疼痛量表评分较低（P < 0.001）。PA组患者在术后1、2、4和8周时肌肉酸痛、呼吸急促、疲劳和食欲不振的情况也较少（P < 0.05），术后1天（1.59 vs. 0.97 l/s；P < 0.02）和3天（2.20 vs. 1.49 l/s；P < 0.03）的FEV更好，术后1、2和3天的去甲肾上腺素水平更低（P = 0.005）。杜克活动量表问卷调查结果表明，更多的PA组患者在术后1周能够行走1 - 2个街区，在术后1和2周能够爬楼梯，在术后1和2周能够进行轻度或中度家务劳动，在术后4和8周能够进行中度娱乐活动并从事重度家务劳动（P < 0.05）。
这些结果表明，与STD冠状动脉搭桥患者相比，PA冠状动脉搭桥患者在术后生理和生活质量方面具有显著优势，在术后前2个月疼痛更少、早期应激反应更小、肺功能更好且杜克活动量表评分更高。
