门手术的变化模式
V Rao1, G T Christakis, R D Weisel
1Division of Cardiovascular Surgery, Toronto Hospital, Ontario, Canada.
Circulation
|November 1, 1996
概括
尽管接受大动脉 (AVR) 和 mitra (MVR) 门置换的高风险患者数量增加,但结果保持稳定. 这项研究表明,对于这些复杂的门手术,死亡率或发病率没有显著上升.
科学领域:
- 心血管外科心血管外科
- 胸部外科手术 胸部外科手术
- 医疗技术 医疗技术 医学技术
背景情况:
- 手术技术和心肌保护改善了大动脉和心肌关节手术的结果.
- 门维修的进步减少了门更换的需要.
- 需要进行门置换的患者往往患有晚期疾病和化,增加了手术风险.
研究的目的:
- 为了在两个不同的时间段之间比较大动脉 (AVR) 和友 (MVR) 门置换的结果.
- 确定术后低输出综合征 (LOS) 和手术死亡率 (OM) 的预测因素.
- 评估不断变化的患者风险概况对手术结果的影响.
主要方法:
- 在多伦多医院接受AVR或MVR的2898名患者的回顾性审查.
- 早期手术组 (1982-1986) 与晚期手术组 (1989-1993) 的比较.
- 单变量和多变量分析以确定LOS和OM的预测因素.
主要成果:
- 晚期AVR组 (n=997) 与早期组 (n=782) 相比,有更多的高风险患者,但LOS发病率较低 (10%与14%,P=.012) 和类似的手术后死亡率 (3.4%与3.7%,P=.732).
- 晚期MVR组 (n=493) 也有更多的高风险患者,与早期组 (n=626) 相比,LOS (19%对21%,P=.361) 或OM (5.8%对6.9%,P=.432) 没有显著差异.
- 多变量分析证实AVR和MVR在晚期组中增加了手术前风险因素.
结论:
- 尽管接受AVR和MVR的高风险患者比例不断增加,但手术后的死亡率和发病率并没有显著增加.
- 手术的进步和术后护理似乎可以减轻复杂的门置换病例中的风险.
- 尽管患者复杂性在不断变化,大动脉和 mitra 门置换的结果仍然稳定.
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