本文選題：完全胸腔鏡 + 傳統(tǒng)開胸　； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究目的:對(duì)我國(guó)在完全胸腔鏡下二尖瓣置換術(shù)與正中開胸二尖瓣置換術(shù)的臨床效果進(jìn)行比較,從而為心臟瓣膜置換術(shù)手術(shù)方式選擇提供更加優(yōu)化的思路,以進(jìn)一步提高術(shù)后患者生活質(zhì)量,使心臟瓣膜病患者得到更佳的治療方法,促進(jìn)我國(guó)心臟外科手術(shù)技術(shù)向前發(fā)展。研究方法:通過對(duì)萬方數(shù)據(jù)庫(kù)、維普數(shù)據(jù)庫(kù)、中國(guó)知網(wǎng)、中國(guó)生物醫(yī)學(xué)數(shù)據(jù)庫(kù)中2000年到2016年發(fā)表的醫(yī)學(xué)文獻(xiàn)進(jìn)行檢索,收集關(guān)于完全胸腔鏡下與正中開胸二尖瓣置換術(shù)對(duì)比的有關(guān)文章,按照制定的納入、排除標(biāo)準(zhǔn),最終將7篇符合標(biāo)準(zhǔn)的相關(guān)文獻(xiàn)納入研究,將所有篩選出的文獻(xiàn)的質(zhì)量進(jìn)行評(píng)價(jià),對(duì)文獻(xiàn)中有關(guān)手術(shù)時(shí)間、術(shù)中體外循環(huán)時(shí)間、術(shù)中升主動(dòng)脈阻斷時(shí)間、術(shù)后呼吸機(jī)使用時(shí)間、術(shù)后ICU監(jiān)測(cè)時(shí)間、術(shù)后胸腔引流量、術(shù)后并發(fā)癥發(fā)生率及術(shù)后住院時(shí)間的對(duì)比數(shù)據(jù)進(jìn)行提取,使用RevMan 5.0軟件行Meta分析。結(jié)果:最終共有7篇文獻(xiàn)被納入分析研究,總病例數(shù)為781例,其中施行完全胸腔鏡下二尖瓣置換術(shù)者367例,正中開胸二尖瓣置換術(shù)者414例。Meta分析提示:兩組升主動(dòng)脈阻斷時(shí)間[WMD=5.86,95%CI(0.18,11.53),P=0.04],術(shù)后呼吸機(jī)使用時(shí)間[WMD=-2.07,95%CI(-3.71,-0.44),P=0.01],術(shù)后胸腔引流量[WMD=-66.57,95%CI(-119.49,-13.66),P=0.01],術(shù)后ICU監(jiān)測(cè)時(shí)間[WMD=-3.57,95%CI(-6.08,-1.05),P=0.006],術(shù)后住院時(shí)間[WMD=-3.01,95%CI(-4.52,-1.50),P0.0001],術(shù)后并發(fā)癥發(fā)生率[OR=0.44,95%CI(0.25,0.79),P=0.005]比較,差異有統(tǒng)計(jì)學(xué)意義;體外循環(huán)時(shí)間[WMD=5.35,95%CI(-0.89,11.59),P=0.09],總體手術(shù)時(shí)間[WMD=0.06,95%CI(-0.25,0.36),P=0.71]比較,差異無統(tǒng)計(jì)學(xué)意義。結(jié)論:在術(shù)后胸腔引流量、術(shù)后呼吸機(jī)使用時(shí)間、術(shù)后ICU監(jiān)測(cè)時(shí)間、術(shù)后住院時(shí)間、術(shù)后并發(fā)癥發(fā)生率方面,完全胸腔鏡下二尖瓣置換術(shù)組整體均明顯低于正中開胸二尖瓣置換術(shù)組,但完全胸腔鏡下二尖瓣置換術(shù)的升主動(dòng)脈阻斷時(shí)間長(zhǎng)于正中開胸二尖瓣置換術(shù)。兩者的總體手術(shù)時(shí)間和術(shù)中體外循環(huán)時(shí)間無明顯差異。
[Abstract]:Objective: to compare the clinical effect of mitral valve replacement under complete thoracoscopic surgery with that of middle thoracotomy mitral valve replacement in China, so as to provide a more optimized method for heart valve replacement. In order to further improve the quality of life of postoperative patients, so that patients with cardiac valve disease to get a better treatment, promote the development of cardiac surgery technology in China. Methods: the medical literature published from 2000 to 2016 in Wanfang Database, Weipu Database, China knowledge Network and China Biomedical Database were searched. To collect relevant articles on the comparison between complete thoracoscopic and median thoracotomy mitral valve replacement, and according to the established inclusion and exclusion criteria, finally include 7 relevant articles that meet the criteria in the study. The quality of all the selected literatures was evaluated. The operative time, the time of extracorporeal circulation, the time of ascending aorta occlusion, the time of ventilator use after operation, the monitoring time of postoperative ICU, the postoperative drainage volume of thoracic cavity were evaluated. The incidence of postoperative complications and postoperative hospitalization time were extracted and Meta analysis was performed with RevMan 5.0 software. Results: a total of 7 articles were included in the study. The total number of cases was 781, of which 367 underwent complete thoracoscopic mitral valve replacement. 姝ｄ腑寮，

本文編號(hào)：1922657