Newcomb Andrew E, Alphonso Nelson, Nørgaard Martin A, Cochrane Andrew D, Karl Tom R, Brizard Christian P
Cardiac Surgery Unit, Royal Children's Hospital, Flemington Road, Parkville, 3052 Melbourne, Victoria, Australia.
Eur J Cardiothorac Surg. 2005 Mar;27(3):395-9; discussion 399-400. doi: 10.1016/j.ejcts.2004.11.023. Epub 2004 Dec 25.
The collection of fluid in the mediastinum after cardiac surgery is traditionally prevented using underwater seal drains that may be connected to low-pressure suction. High-vacuum drains (redivac drains) are a potential alternative to this arrangement and have previously been utilized in areas of general surgery, as well as in the treatment of post-sternotomy mediastinitis. There has been no study to date addressing the safety and efficacy of these drains following pediatric cardiac surgery.
Five hundred and forty-six patients were prospectively randomised to receive either the redivac drains or the conventional underwater-seal drains attached to low-pressure wall suction. We sought to test the null hypothesis that there was no difference in the incidence of residual pericardial or pleural collections requiring drainage between the 2 drainage systems. Secondary endpoints included time to drain removal, volume of drainage and drain size. Analysis was performed on an intention to treat basis.
Two hundred and thirty-seven patients were allocated to the redivac group, while 241 were allocated to the conventional drain group. Age and gender distribution, the use of cardiopulmonary bypass, numbers of patients with univentricular morphology and number of drains utilized were similar in the 2 groups. The use of redivac drains resulted in a significantly lower incidence of residual pleural effusions requiring drainage (4 vs. 18, P=0.003). There was no difference in the incidence of pericardial effusion requiring drainage. Redivac drains drained an equivalent volume through smaller calibre tubes (12 Ch vs. 16 Ch, P<0.0001) over a shorter period of time (42h (IQR 22-45) vs. 43h (IQR 27-52), P<0.01) than the conventional drainage system.
Redivac drains are as safe and effective as conventional drains in the pediatric setting, and resulted in a lower incidence of residual pleural effusions requiring drainage. Together with their ease of care, earlier mobilisation of patients and greater cost-effectiveness, the routine use of high-vacuum drains can be recommended following pediatric heart surgery.
心脏手术后纵隔积液的传统预防方法是使用可连接低负压吸引的水封引流管。高真空引流管（redivac引流管）是这种引流方式的一种潜在替代方案，此前已用于普通外科领域以及胸骨切开术后纵隔炎的治疗。迄今为止，尚无研究探讨小儿心脏手术后使用这些引流管的安全性和有效性。
546例患者被前瞻性随机分组，分别接受redivac引流管或连接低负压墙壁吸引的传统水封引流管。我们试图检验零假设，即两种引流系统在需要引流的残余心包或胸腔积液发生率上没有差异。次要终点包括拔管时间、引流量和引流管尺寸。分析基于意向性治疗原则进行。
237例患者被分配到redivac组，241例被分配到传统引流管组。两组患者的年龄和性别分布、体外循环的使用情况、单心室形态患者数量以及使用的引流管数量相似。使用redivac引流管导致需要引流的残余胸腔积液发生率显著降低（4例对18例，P = 0.003）。需要引流的心包积液发生率没有差异。与传统引流系统相比，redivac引流管通过更细的管道（12 Ch对16 Ch，P < 0.0001）在更短的时间内（42小时（四分位间距22 - 45）对43小时（四分位间距27 - 52），P < 0.01）引出了等量的液体。
在小儿患者中，redivac引流管与传统引流管一样安全有效，且需要引流的残余胸腔积液发生率更低。鉴于其易于护理、患者可更早活动以及更高的成本效益，建议小儿心脏手术后常规使用高真空引流管。
