(广东省心血管病研究所//广东省华南结构性心脏病重点实验室//广东省人民医院//广东省医学科学院1. 流行病学研究室,2. 心脏外科,),广东,广州,510080
纸质出版日期:2017,
网络出版日期:2017-1-20,
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高向民, 聂志强, 欧艳秋, 等. 倾向评分法评估Sutureless 技术治疗完全性肺静脉 异位引流的效果[J]. 中山大学学报(医学科学版), 2017,38(1).
Comparison between Two Surgical Techniques to Repair Total Anomalous Pulmonary Venous Connection Using propensity Scoreanalysis[J]. Journal of Sun Yat-sen University (Medical Sciences), 2017,38(1).
摘要:【目的】以两种治疗先天性心脏病完全性肺静脉异位引流(TAPVC)不同的手术方法(Sutureless技术和传统方 法)为例,应用倾向评分方法评估不同手术方法的优劣。【方法】连续入组2007年10月1日至2013年12月31日本中心所有 行外科矫治术的TAPVC 婴幼儿179 名病例,其中Sutureless 组81 人,传统手术组98 人。病人随访时间为术后1、3、6、12 个 月。采用三种倾向评分方法(最邻近卡钳法、马氏距离法、成对最佳法)匹配基线因素,匹配变量为:术前肺静脉狭窄(Pre- PVO)、年龄、性别、体质量、是否新生儿、TAPVC类型。以随机效应脆弱风险模型验证多水平效应,用Kaplan-Meier 生存分 析与多因素Cox分析方法比较两组手术指标及术后生存率差异。【结果】使用倾向评分中的最邻近卡钳法匹配效果最好。匹 配后,Sutureless组中位数体外循环时间87(74.5 ~ 103.0)min少于传统手术组99(76.5 ~ 123.5)min(P = 0.030);Sutureless组 中位数主动脉阻断时间43(35 ~ 54.5)min 少于传统手术组55(40.5 ~ 705)min(P < 0.001);复合事件发生率Sutureless 组 6.8%(5/73)显著低于传统手术组24.7%(18/73),HR的95%CI = 0.20(0.06 ~ 0.61),P = 0.005。院外死亡发生率Sutureless组 1.4%(1/73)低于传统手术组6.8%(5/73),HR的95%CI = 0.03(0.01~0.55),P = 0.017。两组在术后肺静脉梗阻、围术期死亡率 无统计学差异。【结论】使用倾向评分方法评估先天性TAPVC的不同治疗方法的效果显示,使用Sutureless技术能缩短患者 术中的主动脉阻断时间与体外循环时间,能降低术后复合事件的发生率及院外死亡率。
Abstract:【Objective】To evaluate the effects of sutureless technique in comparison to conventional techniques for repair of total anomalous pulmonary venous connection(TAPVC)with the method of propensity score analysis.【Methods】From October 2007 to December 2013,179 consecutive patients were enrolled in this study. Patients were operated with sutureless technique(n = 81)or Conventional technique(n = 98),and followed up at an interval of 1 month,3 months,6 months and then once a year post-operation. During analysis,three type of propensity-score matching methods,including nearest neighbor caliper matching,Mahalanobis metricmatching with propensity score,optimal full matching were used to create balanced groups of patients receiving each treatment. Surgeons’performance difference was assessed with random frailty proportional hazards models with gamma. Composite endpoints was defined by postoperative death or late death or postoperative pulmonary venous obstruction(PVO),which was evaluated with Kaplan- Meier curve and multivariable Cox proportional hazard model,adjusted by Preoperative-PVO,age,gender,weight and TAPVC type. 【Results】Nearest neighbor caliper matching method was the best choice during propensity score analysis. After matching,sutureless group included 73 patients and Conventional group73 patients. In sutureless group,cardiopulmonary bypass(CPB)time(Z = 2.18, P = 0.030),cross-clamp time(Z = 3.63,P < 0.001),rate of composite endpoints(HR 95% CI= 0.20(0.06~0.61),P = 0.005),late death(HR 95% CI=0.03(0.01~0.55),P = 0.017)were significantly better than that in Conventional group. In subgroup analysis,for patients with pre-PVO,decreased composite endpoints was seen in sutureless group.【Conclusion】Comparison using thepropensity score analysis demonstrated that sutureless strategy for primary repair of TAPVC may associate with decreased mortality rate of post- PVO and CPB time and cross-clamp time.
先天性心脏病完全性肺静脉异位引流倾向评分分析
congenital heart diseasetotal anomalous pulmonary venous connectionpropensity score analysis
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