Light R W, Rogers J T, Cheng D, Rodriguez R M
Pulmonary Disease Program, Saint Thomas Hospital and Vanderbilt University, Nashville, Tennessee 37202, USA.
Ann Intern Med. 1999 Jun 1;130(11):891-6. doi: 10.7326/0003-4819-130-11-199906010-00004.
Large pleural effusions sometimes occur after coronary artery bypass grafting (CABG), but their characteristics and clinical course are largely unknown.
To describe the clinical course and pleural fluid findings in patients with large pleural effusions occurring after CABG.
Retrospective case series.
Tertiary care, university-affiliated, nonprofit teaching hospital.
3707 patients who had CABG between 1 February 1996 and 1 August 1997.
Chest radiographs were reviewed, and information on pleural fluid findings, pleural effusion treatment, and cardiac surgery was obtained from medical records and a cardiac surgery database.
Pleural effusions that occupied more than 25% of the hemithorax were found in 29 patients (0.78%). Seven of the effusions were attributed to congestive heart failure, 2 were attributed to pericarditis, and 1 was attributed to pulmonary embolism. The explanation for the remaining 19 effusions was unclear. All but 2 effusions were predominantly left-sided. Of these 19 effusions, 8 were bloody and 11 were nonbloody. Bloody effusions usually occurred earlier, contained higher lactic acid dehydrogenase levels, and were frequently eosinophilic. Nonbloody effusions tended to be more difficult to manage.
Large pleural effusions may develop in a small proportion of patients after CABG. The cause of many of these effusions is unclear. Most bloody effusions can be managed with one to three therapeutic thoracenteses. Resolution of nonbloody effusions may require anti-inflammatory agents, tube thoracostomy, or intrapleural injection of sclerosing agents.
冠状动脉旁路移植术（CABG）后有时会出现大量胸腔积液，但其特征和临床病程在很大程度上尚不清楚。
描述CABG后出现大量胸腔积液患者的临床病程及胸腔积液检查结果。
回顾性病例系列研究。
三级医疗、大学附属非营利性教学医院。
1996年2月1日至1997年8月1日期间接受CABG的3707例患者。
复查胸部X线片，并从病历和心脏手术数据库中获取有关胸腔积液检查结果、胸腔积液治疗及心脏手术的信息。
29例患者（0.78%）出现胸腔积液，积液量超过半侧胸腔的25%。其中7例积液归因于充血性心力衰竭，2例归因于心包炎，1例归因于肺栓塞。其余19例积液的病因不明。除2例积液外，其余均以左侧为主。在这19例积液中，8例为血性，11例为非血性。血性积液通常出现较早，乳酸脱氢酶水平较高，且常为嗜酸性。非血性积液往往更难处理。
一小部分CABG术后患者可能会出现大量胸腔积液。许多此类积液病因不明。大多数血性积液通过一至三次治疗性胸腔穿刺即可处理。非血性积液的消退可能需要使用抗炎药物、胸腔闭式引流或胸膜腔内注射硬化剂。
