查詢結果分析
來源資料
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題 名 | Safety and Effectiveness of Minimal-Access Versus Conventional Coronary Artery Bypass Grafting in Emergent Patients=微創冠狀動脈繞道手術與傳統手術法施行於急症病患的安全性及效益比較 |
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作 者 | 葉集孝; 林萍章; 朱肇基; 蔡貴棟; 張育生; | 書刊名 | 長庚醫學 |
卷 期 | 25:2 2002.02[民91.02] |
頁 次 | 頁89-96 |
分類號 | 416.262 |
關鍵詞 | 冠狀動脈繞道手術; 微創開心術; 效益; Coronary artery bypass grafting; CABG; Minimal invasive surgery; Cost-effectiveness; |
語 文 | 英文(English) |
中文摘要 | 背景:微創開心術已被廣泛的運用在許多接受常規冠狀動脈繞道手術的病患身上。為評估此種手術方法是否可以施行於緊急冠狀動脈繞道手術的病患,我們比較了使用傳統正中開胸術及微創開胸術下,緊急冠狀動脈繞道手術的結果。 方法:自1996年6月至1998年4月,63位病患因不穩定型心絞痛、冠狀動脈氣球擴張術併發症、或嚴重左主冠狀動脈狹窄接受緊急冠狀動脈繞道手術。10位病患接受經由左側胸骨旁切口的微創冠狀動脈繞道手術,其他53位病患則接受傳統正中胸骨切開術。 結果:在微創冠狀動脈繞道手術組中有2位病患死亡,在傳統正中胸骨開心術組中有13位病患死亡。我們使用美國胸腔學會的電腦程式,推算兩組病患的預估死亡率,發現微創冠狀動脈繞道手術組的病患預估死亡率較高。兩組病患手術結果的比較,發現在主動脈橫夾時間、體外循環時間、加護病房住院時間、及術後住院期間均無顯著差異。但在術後24小時胸管引流量上,微創動脈繞道手術明顯較少。在整體醫療費用上,兩者並無顯著差異。但微創冠狀動脈繞道手術所需的輸血費用明顯較低。 結論:使用微創冠狀動脈繞道手術並不會增加手術的風險及醫療費用,且可以達成傳統冠狀動脈繞道手術的安全及成果。此種術式可以同樣安全、有效的使用於緊急及高危險群的冠狀動脈繞道手術病患。 |
英文摘要 | Background: Myocardial revascularization with a minimal-access incision is used in many patients who undergo an elective coronary artery bypass grafting (CABG) operation. To evaluate whether this method could be used for patients who undergo an emergent CABG operation, we compared patients in whom emergent minimal-access CABG was used as the method of revasculariztion with patients who undergent emergent conventional CABG. Methods: From June 1996 to April 1998, 63 patients underwent emergent CABG operation due to unstable angina, percutaneous transluminal coronary angioplasty accident, or critical left main lesion. Ten patients received minimal-access CABG via limited left parasternal incision (MI), and 53 patients received conventional CABG via median sternotomy (CS). Results: There were 2 deaths in the MI group and 13 deaths in the CS group. We used the Society of Thoracic Surgery computer program to predict the mortality of both groups. The expected hospital mortality of the MI group was significant higher than that of the CS group. The 24-hour drainage amount in the MI group was significant less than that of the CS group. There ware no significant differences in cross-clamping time, the duration of extracorporeal circulation, the intensive care unit stay, or the average hospital stay. Total costs of the MI group were similar to those of the CS group, except that the blood transfusion fee was significantly lower (9406[]1259 vs. 12059[]3994 New Taiwan dollars, p=0.003). Conclusions: This technique combines minimally invasive surgical conditions with the safety and cost standards of emergent CABG surgery. Even emergent and high-risk coronary artery disease can be treated using this approach. |
本系統中英文摘要資訊取自各篇刊載內容。