在有或无心脏停搏情况下进行体外循环下肺动脉瓣置换手术的健康结局：法洛四联症患者的一项比较研究
Health outcomes of on-pump pulmonary valve replacement surgery with and without cardioplegic arrest: a comparison study in tetralogy of Fallot subjects.
作者信息
Chehri Goodarz, Moludi Jalal, Tabaei Ali Sadeghpour, Tabaei Sepehr Sadeghpour
机构信息
Department of Cardiac Surgery, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences Tehran, Iran.
Nutrition Research Center, Faculty of Nutrition, Tabriz University of Medical Sciences Tabriz, Iran.
出版信息
Am J Cardiovasc Dis. 2019 Apr 15;9(2):18-24. eCollection 2019.
BACKGROUND
Tetralogy of Fallot is one of the most common congenital heart diseases in which four important cardiovascular defects. Pulmonary valve regurgitation (PVR) after TOF surgery is one of the indications for its replacement which is carried out with two surgical methods, on-pump surgery with and without cardiac arrest.
OBJECTIVE
The aim of this study was to compare the results of the pulmonary valve replacement surgery with and without cardiac arrest.
MATERIALS AND METHODS
In this retrospective study, the information of medical records of all patients with TOF that candidates for pulmonary valve replacement from 2008 to 2014, whom treated in Kermanshah's Imam Ali cardiac hospital, Kermanshah. Iran and Shaheed Rajaei Heart Center in Tehran with the two common surgical procedure, with and without cardiac arrest, were studied. With matching for age and sex, 33 patients enrolled in this study, 16 patients underwent surgery with the arrest (in Kermanshah's Imam Ali cardiac hospital, Kermanshah. Iran) and 17 subjects operated without cardiac arrest (on pump beating heart in Shaheed Rajaei Heart Center in Tehran).
RESULTS
The results of this study showed that patients operated using without cardiac arrest compared to the with cardiac arrest, were superior in the hospital and ICU stay, bleeding until 24 hours after surgery, intubated time, inotropic support, and duration of surgery (P<0.05). Also, hemoglobin, blood pressure, ejection fraction (EF), and tricuspid regurgitation after surgery were statistically significant difference between two groups (P<0.05).
CONCLUSION
The results of this study showed that although during the (on pump beating heart without aortic cross clamp) without cardiac arrest surgery method some problems may be created for the surgeon, nevertheless, patients after without arrested procedure have a better outcomes compared to the cardiac arrest method.
背景
法洛四联症是最常见的先天性心脏病之一，存在四种重要的心血管缺陷。法洛四联症手术后的肺动脉瓣反流（PVR）是进行瓣膜置换的指征之一，该手术有两种手术方式，即有心脏停搏的体外循环手术和无心脏停搏的体外循环手术。
目的
本研究旨在比较有心脏停搏和无心脏停搏的肺动脉瓣置换手术的结果。
材料与方法
在这项回顾性研究中，对2008年至2014年在伊朗克尔曼沙赫的伊玛目阿里心脏医院和德黑兰的沙希德·拉贾伊心脏中心接受两种常见手术方式（有心脏停搏和无心脏停搏）治疗的所有法洛四联症且适合进行肺动脉瓣置换的患者的病历信息进行了研究。在年龄和性别匹配后，33例患者纳入本研究，16例患者接受了有心脏停搏的手术（在伊朗克尔曼沙赫的伊玛目阿里心脏医院），17例患者接受了无心脏停搏的手术（在德黑兰的沙希德·拉贾伊心脏中心的体外循环下跳动心脏手术）。
结果
本研究结果表明，与有心脏停搏的手术相比，无心脏停搏手术的患者在住院时间、重症监护病房（ICU）停留时间、术后24小时内的出血量、插管时间、血管活性药物支持以及手术持续时间方面更具优势（P<0.05）。此外，两组术后的血红蛋白、血压、射血分数（EF）和三尖瓣反流情况也存在统计学显著差异（P<0.05）。
结论
本研究结果表明，尽管在无主动脉阻断的体外循环下跳动心脏无心脏停搏手术方法可能会给外科医生带来一些问题，但与心脏停搏方法相比，无心脏停搏手术的患者术后结局更好。
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