機器人心臟不停跳下冠狀動脈旁路移植術后中遠期隨訪及其影響因素的研究
發(fā)布時間：2019-01-10 18:35
【摘要】：目的研究機器人心臟不停跳下冠脈旁路移植術中遠期橋血管通暢率、MACCE事件發(fā)生率及生存率及其影響因素。方法1.研究對象：回顧性分析2007年1月至2014年12月我院完成機器人心臟不停跳下冠脈旁路移植術患者的臨床資料。其中,機器人乳內(nèi)動脈游離+胸壁小切口下冠狀動脈旁路移植術(minimally invasive direct coronary artery bypass, MIDCAB)病人140例；全機器人下冠狀動脈旁路移植術(totally endoscopic coronary bypass, TECAB)病人100例；所有手術均在心臟跳動下進行,對部分血管多支病變病人,術后行機器人分站式雜交手術。2.手術方法：MIDCAB組：常規(guī)手術準備后,行雙腔氣管插管,右側單肺通氣,左側胸壁打孔后連接da Vinci機器人系統(tǒng),機器人輔助游離乳內(nèi)動脈后,行胸壁6cm小切口進胸,直視下手工吻合乳內(nèi)動脈于靶血管；TECAB組：全機器人下游離乳內(nèi)動脈并將乳內(nèi)動脈與靶血管吻合。兩組患者術中應用VeriQC系統(tǒng)(Medistim ASA, Norway)測量橋血流。3.術后處理所有患者術后常規(guī)進入CCU單元治療,病情好轉后轉入普通病房繼續(xù)治療,多支血管病變患者,術后2周內(nèi)行支架置入術。出院前,TECAB組行冠脈造影,MIDCAB組行螺旋CT,明確橋血管通暢情況。4.隨訪情況TECAB組隨訪時間40.5+22.5月(3～95月),成功隨訪92人,隨訪率92.0%,MIDCAB組隨訪時間41.2+29.1月(1～97月)成功隨訪128人,隨訪率91.4%。結果1. TECAB組乳內(nèi)動脈使用率100%,橋血流34.5±20.1ml/min,1例因靶血管鈣化嚴重,分支出血較多,暴露困難,改為MIDCAB,1例全鏡下再次探查止血,1例術后早期心肌梗塞(無臨床癥狀),術后2周冠脈造影提示橋血管通暢；MIDCAB組3例應用雙側乳內(nèi)動脈,其余應用單側乳內(nèi)動脈,橋血流21.8±13.7ml/min,無術中死亡,無危及生命的嚴重并發(fā)癥。2. TECAB組17例行分站式雜交手術；MIDCAB組16例行分站式雜交手術。3. TECAB組術后半年、1年、3年、3年以上橋血管通暢率分別為100%,98.86%,98.86%,98.86%；MIDCAB組術后半年、1年、3年、3年以上年橋血管通暢率分別100%,98.78%,97.54%,97.54%。4. TECAB組隨訪期間6例發(fā)生MACCE事件,死亡5例,再血管化1例；MIDCAB組2例發(fā)生MACCE事件,均為再血管化。5. TECAB組術后1年、3年、5年、8年生存率分別為98.91%,96.74%,94.54%,94.54%；MIDCAB組術后1年、3年、5年、8年生存率均為100%。結論1.TECAB組和MIDCAB組術后中遠期橋血管通暢率及術后遠期生存率高、MACCE事件發(fā)生率低,療效均值得肯定。2. TECAB術式及MIDCAB術式安全性及可行性較好,是值得選擇的良好微創(chuàng)手術方式。
[Abstract]:Objective to study the patency rate, the incidence of MACCE events, survival rate and its influencing factors in the long term graft after robotic heart beating coronary artery bypass grafting. Method 1. Participants: the clinical data of patients undergoing coronary artery bypass grafting in our hospital from January 2007 to December 2014 were retrospectively analyzed. There were 140 patients with (minimally invasive direct coronary artery bypass, MIDCAB) and 100 patients with (totally endoscopic coronary bypass, TECAB) after intracoronary artery free small incision coronary artery bypass grafting. All the operations were performed under the beating of the heart. Operation methods: MIDCAB group: after routine operation preparation, double lumen tracheal intubation, right lung ventilation, left chest wall perforation connected with da Vinci robot system, robot-assisted free internal mammary artery, chest wall 6cm small incision were performed. The intramammary artery was manually anastomosed to the target vessel under direct vision. In TECAB group, the internal mammary artery was free and anastomosed with the target vessel. The blood flow of the bridge was measured by VeriQC system (Medistim ASA, Norway) in both groups. 3. 3%. All the patients were treated with CCU unit therapy after operation, the patients were transferred to the general ward after the improvement of the condition, and the patients with multi-vessel disease were treated with stent implantation within 2 weeks after operation. Before discharge, coronary angiography was performed in TECAB group and spiral CT, was performed in MIDCAB group. 4. 4. The follow-up time of TECAB group was 40.5 22.5 months (3 ~ 95 months), and 92 cases were followed up successfully. The follow-up rate of 92.0 MIDCAB group was 41.21 months (1-97 months), and the follow-up rate was 91.4. Result 1. In the TECAB group, the utilization rate of the internal mammary artery was 100 and the blood flow of the bridge was 34.5 鹵20.1 ml / min. Because of the severe calcification of the target vessel, the hemorrhage of the branches was more severe, and the exposure was difficult. 1 case had early myocardial infarction (no clinical symptoms), 2 weeks after the operation, coronary angiography indicated the patency of the grafts. In MIDCAB group, 3 cases were treated with bilateral internal mammary artery and others with unilateral internal mammary artery. The blood flow of the bridge was 21.8 鹵13.7 ml / min. There was no intraoperative death and no serious life-threatening complications. 2. TECAB group (17 cases) and MIDCAB group (16 cases). The patency rates of grafts in TECAB group were 98.86 and 98.86, respectively, half a year, one year, three years and more than three years after operation. In the MIDCAB group, the patency rate of the grafts was 98.78 and 97.547.54, respectively, half a year, one year, three years and more than three years after operation. In TECAB group, 6 cases had MACCE event, 5 cases died and 1 case had re-vascularization, and 2 cases in MIDCAB group had MACCE event, all of which were re-vascularization. The 1 year, 3 year, 5 year and 8 year survival rates of TECAB group were 98.91%, 96.74% and 94.54%, respectively. The survival rates of 1 year, 3 years, 5 years and 8 years after operation in MIDCAB group were 100. Conclusion the middle and long term graft patency rate, long term survival rate and low incidence of MACCE events in 1.TECAB group and MIDCAB group are all worthy of recognition. 2. TECAB and MIDCAB are safe and feasible, which is a good minimally invasive operation.
【學位授予單位】：中國人民解放軍醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R654.2
[Abstract]:Objective to study the patency rate, the incidence of MACCE events, survival rate and its influencing factors in the long term graft after robotic heart beating coronary artery bypass grafting. Method 1. Participants: the clinical data of patients undergoing coronary artery bypass grafting in our hospital from January 2007 to December 2014 were retrospectively analyzed. There were 140 patients with (minimally invasive direct coronary artery bypass, MIDCAB) and 100 patients with (totally endoscopic coronary bypass, TECAB) after intracoronary artery free small incision coronary artery bypass grafting. All the operations were performed under the beating of the heart. Operation methods: MIDCAB group: after routine operation preparation, double lumen tracheal intubation, right lung ventilation, left chest wall perforation connected with da Vinci robot system, robot-assisted free internal mammary artery, chest wall 6cm small incision were performed. The intramammary artery was manually anastomosed to the target vessel under direct vision. In TECAB group, the internal mammary artery was free and anastomosed with the target vessel. The blood flow of the bridge was measured by VeriQC system (Medistim ASA, Norway) in both groups. 3. 3%. All the patients were treated with CCU unit therapy after operation, the patients were transferred to the general ward after the improvement of the condition, and the patients with multi-vessel disease were treated with stent implantation within 2 weeks after operation. Before discharge, coronary angiography was performed in TECAB group and spiral CT, was performed in MIDCAB group. 4. 4. The follow-up time of TECAB group was 40.5 22.5 months (3 ~ 95 months), and 92 cases were followed up successfully. The follow-up rate of 92.0 MIDCAB group was 41.21 months (1-97 months), and the follow-up rate was 91.4. Result 1. In the TECAB group, the utilization rate of the internal mammary artery was 100 and the blood flow of the bridge was 34.5 鹵20.1 ml / min. Because of the severe calcification of the target vessel, the hemorrhage of the branches was more severe, and the exposure was difficult. 1 case had early myocardial infarction (no clinical symptoms), 2 weeks after the operation, coronary angiography indicated the patency of the grafts. In MIDCAB group, 3 cases were treated with bilateral internal mammary artery and others with unilateral internal mammary artery. The blood flow of the bridge was 21.8 鹵13.7 ml / min. There was no intraoperative death and no serious life-threatening complications. 2. TECAB group (17 cases) and MIDCAB group (16 cases). The patency rates of grafts in TECAB group were 98.86 and 98.86, respectively, half a year, one year, three years and more than three years after operation. In the MIDCAB group, the patency rate of the grafts was 98.78 and 97.547.54, respectively, half a year, one year, three years and more than three years after operation. In TECAB group, 6 cases had MACCE event, 5 cases died and 1 case had re-vascularization, and 2 cases in MIDCAB group had MACCE event, all of which were re-vascularization. The 1 year, 3 year, 5 year and 8 year survival rates of TECAB group were 98.91%, 96.74% and 94.54%, respectively. The survival rates of 1 year, 3 years, 5 years and 8 years after operation in MIDCAB group were 100. Conclusion the middle and long term graft patency rate, long term survival rate and low incidence of MACCE events in 1.TECAB group and MIDCAB group are all worthy of recognition. 2. TECAB and MIDCAB are safe and feasible, which is a good minimally invasive operation.
【學位授予單位】：中國人民解放軍醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R654.2
【相似文獻】
相關期刊論文 前10條
1 張麗;翟娟娟;;機器人手術的應用[J];全科護理;2010年13期
2 武少杰;;一個通過觸診能夠自動完成診斷任務的先進的機器人系統(tǒng)[J];國外醫(yī)學.生物醫(yī)學工程分冊;1988年03期
3 朱帆三;;一種通過觸摸而自動診斷的先進機器人系統(tǒng)[J];國外醫(yī)學.生物醫(yī)學工程分冊;1988年05期
4 索鴻英;形形色色的機器人[J];世界科學技術;1998年02期
5 劉林森;;機器人——信息化時代的白衣天使[J];科學之友(A版);2008年03期
6 胡宇川,季林紅;從醫(yī)學角度探討偏癱上肢康復訓練機器人的設計[J];中國臨床康復;2004年34期
7 王田苗;;為什么機器人會用于臨床[J];中國醫(yī)藥生物技術;2007年02期
8 伍勝;;機器人在食品包裝中的應用[J];食品安全導刊;2010年06期
9 楊鑫;李占賢;徐衛(wèi)國;;外科手術機器人的研究現(xiàn)狀與進展[J];河北聯(lián)合大學學報(醫(yī)學版);2012年02期
10 F.Bortz;張建新;;H.西蒙關于制造聰明的機器人的談話[J];心理學動態(tài);1985年03期
相關會議論文 前10條
1 王靜;邊繼東;張大慧;林峰華;張宏;;管道定量采樣機器人系統(tǒng)設計[A];2009全國虛擬儀器大會論文集（二）[C];2009年
2 黃海明;楊雷;宋躍;賴思沅;;智能保安巡邏機器人[A];2009全國虛擬儀器大會論文集（二）[C];2009年
3 王明輝;馬書根;李斌;;獨立操作型可重構機器人群體的動態(tài)層次體系結構研究[A];第八屆全國信息獲取與處理學術會議論文集[C];2010年
4 許家中;孔祥冰;尤波;李長峰;禹鑫q，
本文編號：2406654
本文鏈接：http://sikaile.net/yixuelunwen/waikelunwen/2406654.html
最近更新
教材專著
