迷你化体外循环设备在微创心脏外科中的应用研究
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摘要
迷你体外循环技术在心脏外科中应用的荟萃分析
目的：尽管迷你体外循环(MECC)技术在欧洲的临床使用已经超过十年,与常规体外循环相比其在临床上的优势仍存在一定争议,就此问题我们针对过往的相关文献进行了大规模的系统评价和荟萃分析。探讨其在临床中的应用价值和在未来体外循环中应用的前景。
方法：我们对PubMed, EMBASE和Cochrane Library数据库进行了相关文献的检索。使用Statal2.0软件进行了合并效应量的计算,并通过敏感性分析和meta回归进行了异质性来源的分析。进行累计性分析,观察合并效应量随时间的变化。观察漏斗图,并对研究进行Begg's和Egger's检验,以评估文献是否存在发表偏倚。
结果：通过数据库检索共纳入41项研究,共计3202名进行心脏手术的成年患者。MECC可以显著降低输血率(RR,0.5；95%CI,0.3-0.84；P=0.009；I2=68.6%),房颤率(RR,0.71；95%CI,0.58～0.86；P=0.001；I2=0%),和心梗率(RR,0.458;95%CI,0.26～0.806; P=0.007; I2=0%)。此外,MECC组的出血量、新鲜冰冻血浆输注量、血小板计数、红细胞输注量、ICU时间和肌钙蛋白T均显著低于常规体外循环组。Meta回归分析的结果显示,在术区左室射血分数较低或有较高欧洲心脏手术风险评分的患者中,MECC的优势更为明显。
结论：MECC可以保护血液,减少血制品的输入,并能降低术后心血管并发症的发生。Meta回归分析的结果提示我们术前状况较差的患者,MECC降低输血率的优势更为明显。
评估体外循环过程中三种不同血液回收设备对红细胞功能的影响
目的：应用MECC系统过程中,术野回吸血液全部采用cell saver进行处理,而不是重新回到系统,本研究旨在评估我院三种不同的血液回收设备在体外循环(CPB)回收清洗过程中对红细胞功能的影响,为使用MECC提供最佳的红细胞处理设备。
方法：将30例CPB的成年病人随机分入3组：组C (Cell Saver5+; Haemonetics, n=10),组M (Autolog; Medtronic, n=10),和组F (CATS; Fresenius HemoCare, n=10)。分别从回收罐及输血袋中采血样。回收罐及洗过的红细胞进行：红细胞聚集指数(AI),变形性指数(DI),红细胞压积校正的全血粘度(HV),2,3-二磷酸甘油酸(2,3-DPG),红细胞压积(Hct),血红蛋白(Hb),葡萄糖(Glu),乳酸(Lac),血尿素氮(BUN),游离血红蛋白清除率(△fHb)的比较。
结果：三组之间AI值在处理后没有统计学差异(组C,53.07±6.54,组M,51.13±4.68,组F,53.49±3.51)。处理后,与组F(0.117+0.07)相比,组C(0.158±0.07,P=0.026)和组M(0.152±0.04,P=0.032)有相对较高的DI值。同时组M有最低的HV(44.69±8.50,P=0.022)。与组M(2.32±0.44,P=0.001)和组F(2.49±0.45,P=0.001)相比较,组C有较低的△2,3-DPG(1.06±0.31)。组F能提供最高Hct (57±5.514%, P=0.021;0.046)和Hb(17.87±1.69,P=0.008；0.013)值。另外,组C(0.258±0.12,P=0.035)和组M(0.333±0.15,P=0.038)具有较高的游离血红蛋白清除率(△fHb),并且与组F相比有显著统计学差异。
结论：血液回收设备具有相同的以离心为基础的工作原理,但基于其设计的不同,对处理过的红细胞功能的影响,以及对有害物质的清除效果在不同设备之间存在明显差异。
迷你体外循环应用初探：10例迷你体外循环回顾分析
目的：总结2012年7月至2012年8月间我院10例使用迷你体外循环(MECC)技术行心脏直视手术的初步临床体会,结合相关文献及最新进展,对MECC在微创心外科(MICS)中的应用价值进行临床的初步分析和评估。探讨其在未来微创外科中的应用价值和前景。
方法：回顾性分析我院10例使用MECC接受心脏直视手术的患者(实验组)基本资料。其中8例患者行正中切口冠状动脉旁路移植术(CABG),2例行胸骨上段小切口主动脉瓣置换术(AVR)。对比同期随机选取的10例使用传统CPB(cardiopulmonary bypass,CPB)行心脏直视手术的成人患者(对照组),结合MECC方案,对其术中体外循环管理方法和术后临床结果进行相应总结。
结果：实验组10例患者无死亡且顺利出院,围术期仅有一名MECC组患者输血2个单位；CPB时间为93.7±±19.9mmin,主动脉阻断时间为54.8±18.5min;转前的Hct为36.5±5.2%,停机后为28.6±±4.7%,回到ICU后33.5±2.8%,患者的拔管时间和ICU停留时间为144±5.7h和39.3±19.4h,胸液引流量为424±156.2ml。各项指标对比传统CPB组,除主动脉阻断时间明显缩短外(P=0.021),其他差异均无统计学意义。
结论：MECC是一种安全有效的体外循环技术,其作为MICS的辅助手段,可能在减少患者输血和促进术后恢复方面起到更有效的作用。但由于本组患者数目较少,就目前收集的数据两组间临床结果没有显著差异。
负压辅助静脉引流技术在全胸腔镜微创心脏手术中的应用研究
目的：总结从2011年1月到2013年3月我院开展的全胸腔镜下心脏手术,比较负压辅助静脉引流(VAVD)和重力引流两种不同引流方式在全胸腔镜心脏手术中对术中流量的影响。探讨和总结VAVD技术和股动静脉插管型号在股动静脉转流中的相关经验。
方法：自2011年1月17日至2013年3月6日,从我院选取拟施微创心脏外科手术患者39例,其中33例为房间隔缺损修补术,3例二尖瓣置换术,2例为房间隔缺损+三尖瓣成型术,1例三房心畸形矫治。将患者分为两组：A组(n=18)依靠重力引流,不使用VAVD; B组(n=21)使用VAVD。按各组方案建立体外循环,比较是否使用VAVD的临床结果。为充分显露术野,后25例将双极股静脉插管改为单极股静脉插管和直角上腔插管。
结果：全部患者术中引流充分,无院内死亡,无因失血而再次开胸病例。术中输血A组3人,B组无输血病例。术中液体输入总量A组为3382.26±1195.74ml,B组为2471.95±823.29ml,使用VAVD的B组液体输入总量显著低于A组(P=0.008)。其他指标无统计学差异。
结论：患者近期手术疗效满意,更合理地应用外周插管和VAVD可使手术过程更为平稳顺利。
What Have We Known about Minimized Extracorporeal circulation versus Conventional Extracorporeal circulation? A Meta-analysis of Randomized Controlled Trials
Objective The benefits of minimized extracorporeal circulation (MECC) compared with conventional extracorporeal circulation (CECC) are still in debate. We performed a system review and meta-analysis to evaluate the evidence of protective effects owed to MECC.
Methods We searched PubMed, EMBASE and Cochrane Library for relevant studies. Stata12.0was used to analysis-pooled results, heterogeneity searching and cumulative analysis for changes during time. To evaluate publication bias, visual observation of funnel plot, Egger's test and Begg's test were performed.
Results41randomized controlled trials (RCTs) comparing MECC and CECC were retrieved from database searching, enrolling3202adult patients undergoing cardiac surgery. MECC significantly reduced transfusion rate (RR,0.5;95%CI,0.3to0.84; P=0.009; I2=68.6%), atrial fibrillation (RR,0.71;95%CI,0.58to0.86; P=0.001; I2=0%), and myocardial infarction (RR,0.458;95%CI,0.26to0.806; P=0.007; I2=0%). In addition, bleeding volume, fresh frozen plasma (FFP) transfusion volume, platelet count, red blood cell transfusion volume,1CU time, and cardiac troponin T (cTnT) were also reduced in MECC group. After meta-regression analysis, we found the trend that for patients with lower left ventricular ejection fraction (LVEF), the benefit of MECC for transfusion rate was more outstanding.
Conclusion MECC did conserve blood cells, and reduce transfusion of blood production. It also reduced cardiovascular complications postoperatively. The results from meta-regression analysis showed that for patients in a more critical state, those patients who used MECC showed lower transfusion rate.
Comparison the Effects of Three Cell Saver Devices on Erythrocyte Function during Cardiopulmonary Bypass Procedure
Objective Cell salvage devices are routinely used to process red blood cells (RBCs) shed during cardiac surgery. The purpose of this study was to evaluate three commercially available cell saver (CS) devices in terms of erythrocyte function and the quality of washed RBCs during cardiopulmonary bypass (CPB).
Methods Thirty patients undergoing CPB were randomly allocated to three CS devices: Group C (Cell Saver5+; Haemonetics, n=10), Group M (Autolog; Medtronic, n=10), and Group F (CATS; Fresenius HemoCare, n=10). Blood samples were collected from reservoirs and transfusion bags. Reservoir's and washed RBCs were analyzed for erythrocyte aggregation index (AI), deformation index(D1) and hematocrit viscosity (HV),2,3-diphosphoglycerate (2,3-DPG), hemotacrit (Hct), hemoglobin (Hb), free hemoglobin removal (△fHb), glucose (Glu), lactate (Lac), as well as blood urea nitrogen (BUN).
Results After processing, Group C (P=0.026) and M (P=0.032) had relatively higher erythrocyte DI compare with Group F.Group C had lower△2,3-DPG compare with Group M (P=0.001)and F(P=0.001). Group F provides the maximal concentration of Hct (P=0.021;0.046) and Hb (P=0.008;0.013). In addition, Group C (P=0.035) and M (P=0.038) had the higher removal of fHb (△fHb) and had significant difference comparing with Group F.
Conclusion CS devices use the same theory of centrifugation, however based on the different design, the function of the washed erythrocyte and undesirable content removal efficiency differs widely from one device to another.
Preliminary Experiences with Minimal extracorporeal circulation:A Case Series
Objective:This report summarizes the preliminary experiences of10cases with minimized extracorporeal circulation (MECC) in our hospital from July2012to August2012. Along with recent literature and progress in MECC, we aim to evaluate the safety and efficacy of MECC in minimally invasive cardiac surgery (MICS)
Methods:Ten patients with application of MECC (experimental group) were analyzed in our institution retrospectively. Eight patients underwent traditional full median sternotomy coronary artery bypass grafting (CABG), and two patients underwent modified median mini-sternotomy aortic valve replacement (AVR). We report our MECC perfusion protocol; summarize the intraoperative managements and postoperative clinical outcomes compared with ten cases of conventional extracorporeal circulation (CECC)(control group)
Results:All patients were discharged in the experimental group. Only one patient required perioperative blood transfusion. CPB time was93.7±19.9min, and aortic clamp time was54.8±18.5min. Preoperative mean hematocrit (HCT) was36.5±5.2%, mean HCT after neutralized was28.6±4.7%and mean HCT in ICU was33.5±2.8%. Duration of mechanical ventilation was14±5.7h, length of ICU stay was39.3±19.4h, and24hours chest tube drainage was424±156.2ml. Compared with CECC, there were no differences between the two groups except the aortic clamp time (P=0.021)
Conclusions:Application of MECC is both safe and effective. As a complementary technology in MICS, MECC appears to play a more important role in reducing blood transfusion and improving clinical outcomes.
Using VAVD Technique to achevie full flow femoral-femoral bypass during Vedio-assisted Cardiac Surgery
Objective:As minimally invasive cardiac surgery (MICS) became a trend and widely used, perfusion management improved a lot correspondingly. We reviewed the experience of our institue39cases patients underwent vedio-assisted cardiac surgery (VACS) with using different cannulation stratagy during cardiopulmonary bypass.
Methods:From Jan17th2011to Mar6th2013, we performed39MICSs.33of the participants underwent atrial sepal defect closure,3underwent mitral valve replacement,2atrial septal defect closure combined tricuspid valve annuloplasty,1cor triatrium. Patients were assigned randomly into Group A(n=18), without VAVD; or Group B(n=21), with VAVD. Cardiopulmonary bypass (CPB) accomplished with peripheral cannulation. To exposure the operative field more clearly, we use uni-polar femoral vein tubes instead of double-polar ones in the latter25surgeries.
Results:There was no in hospital death, and no reexploration for bleeding either.3in Group A had red blood cell infusion, no one in Group B had. The total volume of infused liquid in Group A was3382.26±1195.74ml, and in Group B was2471.95±823.29ml (P=0.008) There was no significant difference for other outcomes.
Conclusion:The short-term outcomes of perfusion management during MICS were satisfied. To modify peripheral cannulation method and use VAVD can make the operation more safe and successful.
目的：尽管迷你体外循环(MECC)技术在欧洲的临床使用已经超过十年,与常规体外循环相比其在临床上的优势仍存在一定争议,就此问题我们针对过往的相关文献进行了大规模的系统评价和荟萃分析。探讨其在临床中的应用价值和在未来体外循环中应用的前景。
方法：我们对PubMed, EMBASE和Cochrane Library数据库进行了相关文献的检索。使用Statal2.0软件进行了合并效应量的计算,并通过敏感性分析和meta回归进行了异质性来源的分析。进行累计性分析,观察合并效应量随时间的变化。观察漏斗图,并对研究进行Begg's和Egger's检验,以评估文献是否存在发表偏倚。
结果：通过数据库检索共纳入41项研究,共计3202名进行心脏手术的成年患者。MECC可以显著降低输血率(RR,0.5；95%CI,0.3-0.84；P=0.009；I2=68.6%),房颤率(RR,0.71；95%CI,0.58～0.86；P=0.001；I2=0%),和心梗率(RR,0.458;95%CI,0.26～0.806; P=0.007; I2=0%)。此外,MECC组的出血量、新鲜冰冻血浆输注量、血小板计数、红细胞输注量、ICU时间和肌钙蛋白T均显著低于常规体外循环组。Meta回归分析的结果显示,在术区左室射血分数较低或有较高欧洲心脏手术风险评分的患者中,MECC的优势更为明显。
结论：MECC可以保护血液,减少血制品的输入,并能降低术后心血管并发症的发生。Meta回归分析的结果提示我们术前状况较差的患者,MECC降低输血率的优势更为明显。
评估体外循环过程中三种不同血液回收设备对红细胞功能的影响
目的：应用MECC系统过程中,术野回吸血液全部采用cell saver进行处理,而不是重新回到系统,本研究旨在评估我院三种不同的血液回收设备在体外循环(CPB)回收清洗过程中对红细胞功能的影响,为使用MECC提供最佳的红细胞处理设备。
方法：将30例CPB的成年病人随机分入3组：组C (Cell Saver5+; Haemonetics, n=10),组M (Autolog; Medtronic, n=10),和组F (CATS; Fresenius HemoCare, n=10)。分别从回收罐及输血袋中采血样。回收罐及洗过的红细胞进行：红细胞聚集指数(AI),变形性指数(DI),红细胞压积校正的全血粘度(HV),2,3-二磷酸甘油酸(2,3-DPG),红细胞压积(Hct),血红蛋白(Hb),葡萄糖(Glu),乳酸(Lac),血尿素氮(BUN),游离血红蛋白清除率(△fHb)的比较。
结果：三组之间AI值在处理后没有统计学差异(组C,53.07±6.54,组M,51.13±4.68,组F,53.49±3.51)。处理后,与组F(0.117+0.07)相比,组C(0.158±0.07,P=0.026)和组M(0.152±0.04,P=0.032)有相对较高的DI值。同时组M有最低的HV(44.69±8.50,P=0.022)。与组M(2.32±0.44,P=0.001)和组F(2.49±0.45,P=0.001)相比较,组C有较低的△2,3-DPG(1.06±0.31)。组F能提供最高Hct (57±5.514%, P=0.021;0.046)和Hb(17.87±1.69,P=0.008；0.013)值。另外,组C(0.258±0.12,P=0.035)和组M(0.333±0.15,P=0.038)具有较高的游离血红蛋白清除率(△fHb),并且与组F相比有显著统计学差异。
结论：血液回收设备具有相同的以离心为基础的工作原理,但基于其设计的不同,对处理过的红细胞功能的影响,以及对有害物质的清除效果在不同设备之间存在明显差异。
迷你体外循环应用初探：10例迷你体外循环回顾分析
目的：总结2012年7月至2012年8月间我院10例使用迷你体外循环(MECC)技术行心脏直视手术的初步临床体会,结合相关文献及最新进展,对MECC在微创心外科(MICS)中的应用价值进行临床的初步分析和评估。探讨其在未来微创外科中的应用价值和前景。
方法：回顾性分析我院10例使用MECC接受心脏直视手术的患者(实验组)基本资料。其中8例患者行正中切口冠状动脉旁路移植术(CABG),2例行胸骨上段小切口主动脉瓣置换术(AVR)。对比同期随机选取的10例使用传统CPB(cardiopulmonary bypass,CPB)行心脏直视手术的成人患者(对照组),结合MECC方案,对其术中体外循环管理方法和术后临床结果进行相应总结。
结果：实验组10例患者无死亡且顺利出院,围术期仅有一名MECC组患者输血2个单位；CPB时间为93.7±±19.9mmin,主动脉阻断时间为54.8±18.5min;转前的Hct为36.5±5.2%,停机后为28.6±±4.7%,回到ICU后33.5±2.8%,患者的拔管时间和ICU停留时间为144±5.7h和39.3±19.4h,胸液引流量为424±156.2ml。各项指标对比传统CPB组,除主动脉阻断时间明显缩短外(P=0.021),其他差异均无统计学意义。
结论：MECC是一种安全有效的体外循环技术,其作为MICS的辅助手段,可能在减少患者输血和促进术后恢复方面起到更有效的作用。但由于本组患者数目较少,就目前收集的数据两组间临床结果没有显著差异。
负压辅助静脉引流技术在全胸腔镜微创心脏手术中的应用研究
目的：总结从2011年1月到2013年3月我院开展的全胸腔镜下心脏手术,比较负压辅助静脉引流(VAVD)和重力引流两种不同引流方式在全胸腔镜心脏手术中对术中流量的影响。探讨和总结VAVD技术和股动静脉插管型号在股动静脉转流中的相关经验。
方法：自2011年1月17日至2013年3月6日,从我院选取拟施微创心脏外科手术患者39例,其中33例为房间隔缺损修补术,3例二尖瓣置换术,2例为房间隔缺损+三尖瓣成型术,1例三房心畸形矫治。将患者分为两组：A组(n=18)依靠重力引流,不使用VAVD; B组(n=21)使用VAVD。按各组方案建立体外循环,比较是否使用VAVD的临床结果。为充分显露术野,后25例将双极股静脉插管改为单极股静脉插管和直角上腔插管。
结果：全部患者术中引流充分,无院内死亡,无因失血而再次开胸病例。术中输血A组3人,B组无输血病例。术中液体输入总量A组为3382.26±1195.74ml,B组为2471.95±823.29ml,使用VAVD的B组液体输入总量显著低于A组(P=0.008)。其他指标无统计学差异。
结论：患者近期手术疗效满意,更合理地应用外周插管和VAVD可使手术过程更为平稳顺利。
What Have We Known about Minimized Extracorporeal circulation versus Conventional Extracorporeal circulation? A Meta-analysis of Randomized Controlled Trials
Objective The benefits of minimized extracorporeal circulation (MECC) compared with conventional extracorporeal circulation (CECC) are still in debate. We performed a system review and meta-analysis to evaluate the evidence of protective effects owed to MECC.
Methods We searched PubMed, EMBASE and Cochrane Library for relevant studies. Stata12.0was used to analysis-pooled results, heterogeneity searching and cumulative analysis for changes during time. To evaluate publication bias, visual observation of funnel plot, Egger's test and Begg's test were performed.
Results41randomized controlled trials (RCTs) comparing MECC and CECC were retrieved from database searching, enrolling3202adult patients undergoing cardiac surgery. MECC significantly reduced transfusion rate (RR,0.5;95%CI,0.3to0.84; P=0.009; I2=68.6%), atrial fibrillation (RR,0.71;95%CI,0.58to0.86; P=0.001; I2=0%), and myocardial infarction (RR,0.458;95%CI,0.26to0.806; P=0.007; I2=0%). In addition, bleeding volume, fresh frozen plasma (FFP) transfusion volume, platelet count, red blood cell transfusion volume,1CU time, and cardiac troponin T (cTnT) were also reduced in MECC group. After meta-regression analysis, we found the trend that for patients with lower left ventricular ejection fraction (LVEF), the benefit of MECC for transfusion rate was more outstanding.
Conclusion MECC did conserve blood cells, and reduce transfusion of blood production. It also reduced cardiovascular complications postoperatively. The results from meta-regression analysis showed that for patients in a more critical state, those patients who used MECC showed lower transfusion rate.
Comparison the Effects of Three Cell Saver Devices on Erythrocyte Function during Cardiopulmonary Bypass Procedure
Objective Cell salvage devices are routinely used to process red blood cells (RBCs) shed during cardiac surgery. The purpose of this study was to evaluate three commercially available cell saver (CS) devices in terms of erythrocyte function and the quality of washed RBCs during cardiopulmonary bypass (CPB).
Methods Thirty patients undergoing CPB were randomly allocated to three CS devices: Group C (Cell Saver5+; Haemonetics, n=10), Group M (Autolog; Medtronic, n=10), and Group F (CATS; Fresenius HemoCare, n=10). Blood samples were collected from reservoirs and transfusion bags. Reservoir's and washed RBCs were analyzed for erythrocyte aggregation index (AI), deformation index(D1) and hematocrit viscosity (HV),2,3-diphosphoglycerate (2,3-DPG), hemotacrit (Hct), hemoglobin (Hb), free hemoglobin removal (△fHb), glucose (Glu), lactate (Lac), as well as blood urea nitrogen (BUN).
Results After processing, Group C (P=0.026) and M (P=0.032) had relatively higher erythrocyte DI compare with Group F.Group C had lower△2,3-DPG compare with Group M (P=0.001)and F(P=0.001). Group F provides the maximal concentration of Hct (P=0.021;0.046) and Hb (P=0.008;0.013). In addition, Group C (P=0.035) and M (P=0.038) had the higher removal of fHb (△fHb) and had significant difference comparing with Group F.
Conclusion CS devices use the same theory of centrifugation, however based on the different design, the function of the washed erythrocyte and undesirable content removal efficiency differs widely from one device to another.
Preliminary Experiences with Minimal extracorporeal circulation:A Case Series
Objective:This report summarizes the preliminary experiences of10cases with minimized extracorporeal circulation (MECC) in our hospital from July2012to August2012. Along with recent literature and progress in MECC, we aim to evaluate the safety and efficacy of MECC in minimally invasive cardiac surgery (MICS)
Methods:Ten patients with application of MECC (experimental group) were analyzed in our institution retrospectively. Eight patients underwent traditional full median sternotomy coronary artery bypass grafting (CABG), and two patients underwent modified median mini-sternotomy aortic valve replacement (AVR). We report our MECC perfusion protocol; summarize the intraoperative managements and postoperative clinical outcomes compared with ten cases of conventional extracorporeal circulation (CECC)(control group)
Results:All patients were discharged in the experimental group. Only one patient required perioperative blood transfusion. CPB time was93.7±19.9min, and aortic clamp time was54.8±18.5min. Preoperative mean hematocrit (HCT) was36.5±5.2%, mean HCT after neutralized was28.6±4.7%and mean HCT in ICU was33.5±2.8%. Duration of mechanical ventilation was14±5.7h, length of ICU stay was39.3±19.4h, and24hours chest tube drainage was424±156.2ml. Compared with CECC, there were no differences between the two groups except the aortic clamp time (P=0.021)
Conclusions:Application of MECC is both safe and effective. As a complementary technology in MICS, MECC appears to play a more important role in reducing blood transfusion and improving clinical outcomes.
Using VAVD Technique to achevie full flow femoral-femoral bypass during Vedio-assisted Cardiac Surgery
Objective:As minimally invasive cardiac surgery (MICS) became a trend and widely used, perfusion management improved a lot correspondingly. We reviewed the experience of our institue39cases patients underwent vedio-assisted cardiac surgery (VACS) with using different cannulation stratagy during cardiopulmonary bypass.
Methods:From Jan17th2011to Mar6th2013, we performed39MICSs.33of the participants underwent atrial sepal defect closure,3underwent mitral valve replacement,2atrial septal defect closure combined tricuspid valve annuloplasty,1cor triatrium. Patients were assigned randomly into Group A(n=18), without VAVD; or Group B(n=21), with VAVD. Cardiopulmonary bypass (CPB) accomplished with peripheral cannulation. To exposure the operative field more clearly, we use uni-polar femoral vein tubes instead of double-polar ones in the latter25surgeries.
Results:There was no in hospital death, and no reexploration for bleeding either.3in Group A had red blood cell infusion, no one in Group B had. The total volume of infused liquid in Group A was3382.26±1195.74ml, and in Group B was2471.95±823.29ml (P=0.008) There was no significant difference for other outcomes.
Conclusion:The short-term outcomes of perfusion management during MICS were satisfied. To modify peripheral cannulation method and use VAVD can make the operation more safe and successful.
引文
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