Fu Song, Feng Zhi-Cun, Dietmar Schranz
Department of Children's Heart Centre, BAYI Children's Hospital, the Military General Hospital of Beijing PLA, Beijing 100700, China.
Chin Med Sci J. 2010 Mar;25(1):38-43. doi: 10.1016/s1001-9294(10)60018-1.
To investigate the association between preoperative, operative, and postoperative factors and persistent pleural effusion after the extracardiac Fontan procedure.
Ninety-five consecutive patients diagnosed with univentricular heart underwent extracardiac connection using Gore-Tax conduits at the Department of Children's Heart Centre, Justus-Liebig-University Giessen in Germany from June 1996 to July 2007. The outcome measures were duration and volume of chest tube drainage after surgical intervention. The investigated factors included age and weight at the time of operation, anatomical diagnosis, preoperative oxygen saturation, mean pulmonary artery pressure, ventricular end-diastolic pressure, fenestration, cardiopulmonary bypass time, conduit size, postoperative pulmonary artery pressure, administration of angiotensin-converting enzyme inhibitors, and postoperative infection. Associations between these factors and persistent pleural effusion after the extracardiac Fontan procedure were analyzed.
Every patient suffered postoperative effusion. The median duration of postoperative chest tube drainage was 9 days (range, 3-69 days), and the median volume was 12 mL kg(-1) x d(-1) (range, 2.0-37.5 mL x kg(-1) d x (-1)). Thirty-seven (38.9%) patients had pleural drainage for more than 15 days, and the volume in 35 (36.8%) patients exceeded 25 mL x kg(-1) x d(-1). Nineteen (20%) patients required placement of additional chest tubes for re-accumulation of pleural effusion after removal of previous chest tubes. Fifteen (17.8%) patients were hospitalized again due to pleural effusion after discharge. The median length of hospital stay after the operation was 14 days (range, 4-78 days). Multivariate analysis results showed that non-fenestration, low preoperative oxygen saturation, and postoperative infections were independent risk factors for prolonged duration of pleural drainage (P < 0.05). Long cardiopulmonary bypass time, non-fenestration, small conduit size, and low preoperative oxygen saturation were independent risk factors for excessive volume of pleural drainage (P < 0.05).
For reduing postoperative duration and volume of pleural drainage following Fontan procedure, it seems to be important to improve the preoperative oxygen saturation, use large size of conduit, shorten cardiopulmonary bypass time, and make fenestration during the operation, as well as avoid postoperative infections.
探讨心外Fontan手术术前、术中和术后因素与持续性胸腔积液之间的关联。
1996年6月至2007年7月，德国吉森尤斯图斯-利比希大学儿童心脏中心对95例连续诊断为单心室心脏的患者使用Gore-Tex导管进行心外连接。观察指标为手术干预后胸腔闭式引流的持续时间和引流量。研究因素包括手术时的年龄和体重、解剖诊断、术前血氧饱和度、平均肺动脉压、心室舒张末期压力、开窗、体外循环时间、导管尺寸、术后肺动脉压、血管紧张素转换酶抑制剂的使用以及术后感染。分析这些因素与心外Fontan手术后持续性胸腔积液之间的关联。
每位患者术后均出现胸腔积液。术后胸腔闭式引流的中位持续时间为9天（范围3 - 69天），中位引流量为12 mL·kg⁻¹·d⁻¹（范围2.0 - 37.5 mL·kg⁻¹·d⁻¹）。37例（38.9%）患者胸腔引流超过15天，35例（36.8%）患者的引流量超过25 mL·kg⁻¹·d⁻¹。19例（20%）患者在拔除先前胸腔引流管后因胸腔积液再次积聚需要放置额外的胸腔引流管。15例（17.8%）患者出院后因胸腔积液再次住院。术后中位住院时间为14天（范围4 - 78天）。多因素分析结果显示，未开窗、术前低血氧饱和度和术后感染是胸腔引流持续时间延长的独立危险因素（P < 0.05）。体外循环时间长、未开窗、导管尺寸小和术前低血氧饱和度是胸腔引流量过多的独立危险因素（P < 0.05）。
为减少Fontan手术后胸腔引流的持续时间和引流量，改善术前血氧饱和度、使用大尺寸导管、缩短体外循环时间、术中开窗以及避免术后感染似乎很重要。
