Luceri R M, Zilo P, Habal S M, David I B
Holy Cross Hospital, Fort Lauderdale, FL.
Pacing Clin Electrophysiol. 1995 Jan;18(1 Pt 2):168-71. doi: 10.1111/j.1540-8159.1995.tb02498.x.
Twenty-five patients with implantable cardioverter defibrillators (ICDs) implanted intrathoracically (group I) were compared with 25 patients who underwent implant using the nonthoracotomy approach (group II). All systems were implanted by the same medical team, in the same high volume implanting center. Indications for implantation were comparable in both groups. Patient characteristics were not statistically different with the exception of age (66-group I vs 71-group II; P < 0.05). Although left ventricular ejection fractions appeared to differ (32% vs 37%, respectively), this difference was not statistically significant (P = 0.06). ICD models used in group I were: Ventritex Cadence (16), Telectronics Guardian 4211 (2), Medtronic PCD (7); in group II they were: Ventritex Cadence (15), Guardian 4211 (2), and CPI 1600 (1). Total length of hospital stay was 16 +/- 6 days for group I versus 12 +/- 5 for group II (P < 0.05). Number of postoperative days in an intensive care unit was 3.2 +/- 2.8 for group I versus 0.5 +/- 0.6 for group II (P < 0.0001). Postoperative length of stay was 8.2 +/- 3.1 for group I versus 5.7 +/- 4.4 for group II (P < 0.001). Mean total hospital charges for the entire length of stay were $72,918 +/- $26,770 in group I versus $55,031 +/- $42,870 in group II, representing a mean reduction of 21% in global costs for group II patients. These data confirm that nonthoracotomy ICD implantation in an experienced center is associated with significantly shorter hospital stays, a virtual elimination of the need for postoperative intensive care, and globally lower total hospital costs. In addition, the presence of a statistically older population in group II does not negate these beneficial effects.
将25例经胸腔内植入植入式心脏复律除颤器（ICD）的患者（I组）与25例采用非开胸方法植入的患者（II组）进行比较。所有系统均由同一医疗团队在同一高容量植入中心植入。两组的植入指征具有可比性。除年龄外（I组66岁，II组71岁；P<0.05），患者特征在统计学上无差异。虽然左心室射血分数似乎有所不同（分别为32%和37%），但这种差异无统计学意义（P=0.06）。I组使用的ICD型号为：Ventritex Cadence（16台）、Telectronics Guardian 4211（2台）、美敦力PCD（7台）；II组为：Ventritex Cadence（15台）、Guardian 4211（2台）和CPI 1600（1台）。I组的总住院时间为16±6天，II组为12±5天（P<0.05）。I组在重症监护病房的术后天数为3.2±2.8天，II组为0.5±0.6天（P<0.0001）。I组的术后住院时间为8.2±3.1天，II组为5.7±4.4天（P<0.001）。I组整个住院期间的平均总住院费用为72918美元±26770美元，II组为55031美元±42870美元，这表明II组患者的总体费用平均降低了21%。这些数据证实，在经验丰富的中心进行非开胸ICD植入与显著缩短住院时间、几乎无需术后重症监护以及总体住院费用降低相关。此外，II组患者在统计学上年龄较大这一情况并不影响这些有益效果。
