Bauer M, Pasic M, Ewert R, Hetzer R
Deutsches Herzzentrum Berlin, Klinik für Herz-, Thorax- und Gefässchirurgie, Augustenburger Platz 1, D-13353 Berlin, Germany.
J Thorac Cardiovasc Surg. 2001 Apr;121(4):702-7. doi: 10.1067/mtc.2001.111380.
Less-invasive approaches in cardiac operations offer certain cosmetic advantages, but it is unclear whether there are additional positive effects with regard to the postoperative recovery of patients. The aim of this prospective and randomized study was to ascertain whether partial inferior midline sternotomy can improve pulmonary function, one of the best quantifiable parameters of postoperative recovery, after coronary artery bypass operations when compared with the standard full midline approach.
One hundred patients scheduled for elective coronary artery bypass grafting were randomized either for a full median sternotomy (standard sternotomy group, n = 50) or for a partial inferior sternotomy (ministernotomy group, n = 50). The following pulmonary features were assessed: vital capacity, forced expiratory volume, percentage of forced expiratory volume from vital capacity, total lung capacity, residual volume, maximum inspiratory pressure, and maximum expiratory pressure. Tests were performed preoperatively and on the fourth and tenth postoperative days.
On the fourth postoperative day, both groups had a significant decrease in vital capacity (percentage of predicted values) when compared with preoperative values (preoperative vs fourth day: standard sternotomy group, 87.8% +/- 14.3% vs 42.1% +/- 10.2% [P <.0001]; ministernotomy group, 84.5% +/- 14.3% vs 41.5% +/- 11.8% [P <.0001]), with a significant tendency for recovery from the fourth to the tenth postoperative day (fourth vs tenth postoperative day: standard sternotomy group, 42.1% +/- 10.2% vs 66.3% +/- 12.3% [P =.001]; ministernotomy group, 41.5% +/- 11.8% vs 61.3% +/- 13.1 % [P =.002]). There were no differences in any test results between the groups on either the fourth or the tenth postoperative day.
A less-invasive approach for coronary artery bypass operations with a partial inferior sternotomy does not improve early postoperative pulmonary function when compared with the conventional approach with a full sternotomy.
心脏手术中采用侵入性较小的方法具有一定的美容优势，但对于患者术后恢复是否有其他积极影响尚不清楚。这项前瞻性随机研究的目的是确定与标准的全正中切口相比，部分低位正中胸骨切开术在冠状动脉搭桥手术后能否改善肺功能（术后恢复的最佳可量化参数之一）。
100例计划接受择期冠状动脉搭桥术的患者被随机分为全正中胸骨切开术组（标准胸骨切开术组，n = 50）或部分低位胸骨切开术组（小切口胸骨切开术组，n = 50）。评估以下肺部特征：肺活量、用力呼气量、用力呼气量占肺活量的百分比、肺总量、残气量、最大吸气压力和最大呼气压力。术前以及术后第4天和第10天进行检测。
术后第4天，与术前值相比，两组的肺活量（预测值百分比）均显著下降（术前与术后第4天：标准胸骨切开术组，87.8%±14.3%对42.1%±10.2%[P<.0001]；小切口胸骨切开术组，84.5%±14.3%对41.5%±11.8%[P<.0001]），且术后第4天至第10天有显著的恢复趋势（术后第4天与第10天：标准胸骨切开术组，42.1%±10.2%对66.3%±12.3%[P =.001]；小切口胸骨切开术组，41.5%±11.8%对61.3%±13.1%[P =.002]）。术后第4天和第10天，两组的任何检测结果均无差异。
与采用全胸骨切开术的传统方法相比，采用部分低位胸骨切开术的侵入性较小的冠状动脉搭桥手术方法并不能改善术后早期肺功能。
