Li Chunxiang, Gong Xiaolei, Huang Jihong, Zhu Limin, Dong Wei, Zhang Mingjie, Liu Yujie, Xu Zhuoming
Department of Cardiac Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China.
Exp Ther Med. 2021 Apr;21(4):302. doi: 10.3892/etm.2021.9733. Epub 2021 Jan 29.
The present study aimed to assess the effects of repairing ventricular septal defects (VSDs) with right vertical infra-axillary mini-incision (RVAI). A total of 116 patients with VSDs were prospectively enrolled and underwent cardiac surgery between June 2017 and December 2018 at the cardiac intensive care unit of Shanghai Children's Medical Center (Shanghai, China). Of these, 58 patients underwent the RVAI procedure and 58 patients matched 1:1 underwent the standard median sternotomy incision (MSI) procedure and were designated as the control group. The demographic data and clinical outcomes intra- and postoperatively were compared. A bedside lung ultrasound was performed to evaluate the degree of lung injury and the number of B-lines was quantified and compared between the two groups. The sedation and analgesia levels were also assessed after the operation. No significant difference was identified between the two groups regarding the overall cardiopulmonary bypass or aortic cross-clamp time. All patients were extubated within 8 h. The RVAI group had shorter incision lengths (median, 4.6 cm) and less drainage (median, 15 ml) than the MSI group. Furthermore, compared to the MSI group, the RVAI group had a significantly higher number of B-lines in the right lung regions immediately after surgery and at 12 h postsurgery (24.1 and 5.2%, respectively) but eventually exhibited no differences at 24 and 36 h postsurgery; by contrast, there were no differences in the left lung regions. The bedside bispectral index score and the Face, Legs, Activity, Cry, Consolability scale score exhibited no significant differences after the operation. In conclusion, the RVAI procedure appears to be a safe alternative for repairing VSDs in addition to satisfactory cosmetic results and the incision does not interfere with postoperative analgosedation.
本研究旨在评估采用右腋下垂直小切口（RVAI）修复室间隔缺损（VSD）的效果。2017年6月至2018年12月期间，共有116例VSD患者前瞻性入组，并在上海儿童医学中心（中国上海）心脏重症监护病房接受心脏手术。其中，58例患者接受了RVAI手术，58例患者按1:1匹配接受标准正中胸骨切开术（MSI），并被指定为对照组。比较两组的人口统计学数据以及术中和术后的临床结局。进行床旁肺部超声检查以评估肺损伤程度，并对两组的B线数量进行量化和比较。术后还评估了镇静和镇痛水平。两组在体外循环或主动脉阻断时间方面未发现显著差异。所有患者均在8小时内拔管。与MSI组相比，RVAI组的切口长度较短（中位数为4.6 cm），引流量较少（中位数为15 ml）。此外，与MSI组相比，RVAI组术后即刻和术后12小时右肺区域的B线数量明显更多（分别为24.1%和5.2%），但在术后24小时和36小时最终无差异；相比之下，左肺区域无差异。术后床旁脑电双频指数评分和面部、腿部、活动、哭闹、安慰度量表评分无显著差异。总之，除了获得令人满意的美容效果外，RVAI手术似乎是修复VSD的一种安全替代方法，且切口不影响术后镇痛镇静。
