2023 年第 5 期 第 18 卷

上午和下午及晚间不同时间段手术对主动脉瓣置换患者围手术期风险的影响

Effects of operation at different time periods in the morning, afternoon and evening on perioperative risk of patients with aortic valve replacement

作者：郑帅王坚刚张海波王盛宇孟旭

英文作者：Zheng Shuai Wang Jiangang Zhang Haibo Wang Shengyu Meng Xu

单位：首都医科大学附属北京安贞医院心脏外科瓣膜外科中心，北京100029

英文单位：Valve Surgery Center Department of Cardiac Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：主动脉瓣置换；昼夜节律；体外循环

英文关键词：Aorticvalvereplacement;Circadianrhythm;Cardiopulmonarybypass

• 摘要：

• 目的 评价上午、下午、晚间不同时间段手术对主动脉瓣置换患者围手术期风险的影响。方法 回顾性分析2018年1月至2020年12月首都医科大学附属北京安贞医院心脏外科瓣膜外科中心开展单纯主动脉瓣置换181例患者的临床资料，根据手术开始时间分为上午手术组（手术开始时间8：00—10：30，54例）、下午手术组（手术开始时间12：00—14：30，87例）、晚间手术组（手术开始时间17：30—20：00，40例）。比较3组患者术后住院死亡率及不良事件发生风险。结果  上午、下午和晚间手术组各有1例术后住院期间死亡，术后住院死亡率分别为1.9%（1/54）、1.1%（1/87）和2.5%（1/40），3组间比较差异无统计学意义（P=0.853）。3组术后住院脑血管事件发生率、体外循环时间、主动脉阻断时间、住院期间非计划二次手术、主动脉内球囊反搏、体外膜氧合、连续肾脏替代治疗使用情况比较差异均无统计学意义（均P＞0.05）。结论   上午、下午和晚间不同时间段进行外科主动脉瓣置换术后早期死亡和不良事件发生风险无明显差异。晚间行外科主动脉瓣置换是安全的。

• Objective  To evaluate the effects of operation at different time periods in the morning, afternoon and evening on the perioperative risk of patients with aortic valve replacement. Methods From January 2018 to December 2020, the clinical data of 181 patients undergoing simple aortic valve replacement in the Valve Surgery Center, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University were analyzed retrospectively. According to the operation start time, they were divided into morning operation group (operation start time from 8：00 to 10：30, 54 cases), afternoon operation group (operation start time from 12：00 to 14：30, 87 cases), and evening operation group (operation start time from 17：30 to 20：00, 40 cases). The hospital mortality and the risk of adverse events were compared among the three groups. ResultsThere was 1 case of death in the morning, afternoon and evening group during hospitalization after operation, and there was no statistically significant difference in the mortality rate of hospitalization after operation ［1.9%（1/54）, 1.1%（1/87） and 2.5%（1/40）］(P=0.853). There were no statistically significant differences in incidence of postoperative cerebrovascular events, cardiopulmonary bypass time, aortic block time, unplanned secondary surgery during hospitalization, intra-aortic balloon counterpulsation, extracorporeal membrane oxygenation, use of continuous renal replacement therapy among the three groups (all P＞0.05). Conclusions There were no significant differences in the risks of early death and adverse events in patients undergoing surgical aortic valve replacement in the morning, afternoon and evening. Surgical aortic valve replacement at night is safe.