傾向評分法評估Sutureless技術(shù)治療完全性肺靜脈異位引流的效果
發(fā)布時間：2019-05-24 21:41
【摘要】：【目的】以兩種治療先天性心臟病完全性肺靜脈異位引流(TAPVC)不同的手術(shù)方法(Sutureless技術(shù)和傳統(tǒng)方法)為例,應(yīng)用傾向評分方法評估不同手術(shù)方法的優(yōu)劣�！痉椒ā窟B續(xù)入組2007年10月1日至2013年12月31日本中心所有行外科矯治術(shù)的TAPVC嬰幼兒179名病例,其中Sutureless組81人,傳統(tǒng)手術(shù)組98人。病人隨訪時間為術(shù)后1、3、6、12個月。采用三種傾向評分方法(最鄰近卡鉗法、馬氏距離法、成對最佳法)匹配基線因素,匹配變量為:術(shù)前肺靜脈狹窄(PrePVO)、年齡、性別、體質(zhì)量、是否新生兒、TAPVC類型。以隨機(jī)效應(yīng)脆弱風(fēng)險模型驗(yàn)證多水平效應(yīng),用Kaplan-Meier生存分析與多因素Cox分析方法比較兩組手術(shù)指標(biāo)及術(shù)后生存率差異。【結(jié)果】使用傾向評分中的最鄰近卡鉗法匹配效果最好。匹配后,Sutureless組中位數(shù)體外循環(huán)時間87(74.5~103.0)min少于傳統(tǒng)手術(shù)組99(76.5~123.5)min(P=0.030);Sutureless組中位數(shù)主動脈阻斷時間43(35~54.5)min少于傳統(tǒng)手術(shù)組55(40.5~705)min(P0.001);復(fù)合事件發(fā)生率Sutureless組6.8%(5/73)顯著低于傳統(tǒng)手術(shù)組24.7%(18/73),HR的95%CI=0.20(0.06~0.61),P=0.005。院外死亡發(fā)生率Sutureless組1.4%(1/73)低于傳統(tǒng)手術(shù)組6.8%(5/73),HR的95%CI=0.03(0.01~0.55),P=0.017。兩組在術(shù)后肺靜脈梗阻、圍術(shù)期死亡率無統(tǒng)計(jì)學(xué)差異。【結(jié)論】使用傾向評分方法評估先天性TAPVC的不同治療方法的效果顯示,使用Sutureless技術(shù)能縮短患者術(shù)中的主動脈阻斷時間與體外循環(huán)時間,能降低術(shù)后復(fù)合事件的發(fā)生率及院外死亡率。
[Abstract]:[objective] to take two different surgical methods (Sutureless technique and traditional method) for the treatment of complete abnormal pulmonary venous drainage of congenital heart disease (TAPVC). The propensity score method was used to evaluate the advantages and disadvantages of different surgical methods. [methods] from October 1, 2007 to December 31, 2013, there were 179 TAPVC infants undergoing surgical correction in Japan Center, including 81 infants in Sutureless group and 98 infants in traditional operation group. The follow-up time was 1, 3, 6, 12 months after operation. Three tendency scoring methods (nearest clamp method, Mahalanobis distance method, pairwise optimal method) were used to match the baseline factors. The matching variables were (PrePVO), age, sex, body mass, neonatal type and TAPVC type of pulmonary vein stenosis before operation. The random effect vulnerability risk model is used to verify the multi-level effect. Kaplan-Meier survival analysis and multivariate Cox analysis were used to compare the surgical indexes and postoperative survival rate between the two groups. [results] the nearest clamp method had the best matching effect in the usage tendency score. After matching, the median cardiopulmonary bypass time of 87 (74.5 鈮，
本文編號：2485204
[Abstract]:[objective] to take two different surgical methods (Sutureless technique and traditional method) for the treatment of complete abnormal pulmonary venous drainage of congenital heart disease (TAPVC). The propensity score method was used to evaluate the advantages and disadvantages of different surgical methods. [methods] from October 1, 2007 to December 31, 2013, there were 179 TAPVC infants undergoing surgical correction in Japan Center, including 81 infants in Sutureless group and 98 infants in traditional operation group. The follow-up time was 1, 3, 6, 12 months after operation. Three tendency scoring methods (nearest clamp method, Mahalanobis distance method, pairwise optimal method) were used to match the baseline factors. The matching variables were (PrePVO), age, sex, body mass, neonatal type and TAPVC type of pulmonary vein stenosis before operation. The random effect vulnerability risk model is used to verify the multi-level effect. Kaplan-Meier survival analysis and multivariate Cox analysis were used to compare the surgical indexes and postoperative survival rate between the two groups. [results] the nearest clamp method had the best matching effect in the usage tendency score. After matching, the median cardiopulmonary bypass time of 87 (74.5 鈮，
本文編號：2485204
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