Lawton J S, Ellenbogen K A, Wood M A, Stambler B S, Spratt J A, Wechsler A S, Damiano R J
Division of Cardiothoracic Surgery, Medical College of Virginia, Richmond 23298-0068, USA.
Ann Thorac Surg. 1995 May;59(5):1092-8; discussion 1098-9. doi: 10.1016/0003-4975(95)00113-y.
A new generation of defibrillators has been introduced that do not require a thoracotomy. The purpose of this report was to examine 100 consecutive nonthoracotomy implantations at our institution and compare them with a series of 102 patients undergoing thoracotomy implantations by the same surgeon over a 4-year period between August 1989 and September 1994. The two groups were comparable for age, sex, comorbidity, cardiac disease status, ejection fraction, and electrophysiologic presentation. Nonthoracotomy systems were implanted successfully in 94% of patients. Patients undergoing a nonthoracotomy implantation had significantly shorter intensive care unit (1.7 +/- 1.7 versus 3.3 +/- 3.9 days; p < 0.005) and postoperative stays (5.0 +/- 2.8 versus 9.5 +/- 5.6 days; p < 0.001) than patients undergoing a thoracotomy approach. This was due to a significant decrease in the incidence of postoperative complications from 29% in the thoracotomy group to 11% in the nonthoracotomy group (p < 0.001). There was no significant difference in overall mortality rates. Nonthoracotomy systems are implantable in the majority of patients and are associated with less morbidity and shorter hospital stays than traditional thoracotomy approaches.
新一代除颤器已经问世，无需开胸手术。本报告的目的是对我院连续100例非开胸植入手术进行研究，并与1989年8月至1994年9月期间同一位外科医生进行的102例开胸植入手术患者进行比较。两组在年龄、性别、合并症、心脏病状况、射血分数和电生理表现方面具有可比性。94%的患者成功植入了非开胸系统。与开胸手术患者相比，接受非开胸植入手术的患者在重症监护病房的住院时间显著缩短（1.7±1.7天对3.3±3.9天；p<0.005），术后住院时间也显著缩短（5.0±2.8天对9.5±5.6天；p<0.001）。这是由于术后并发症的发生率从开胸组的29%显著降至非开胸组的11%（p<0.001）。总体死亡率没有显著差异。大多数患者都可以植入非开胸系统，与传统的开胸手术相比，其发病率更低，住院时间更短。
