Borasino Santiago, Diaz Franco, El Masri Kamal, Dabal Robert J, Alten Jeffrey A
Department of Pediatrics, Division of Critical Care, University of Alabama at Birmingham, Birmingham, AL, USA
Department of Pediatrics, Division of Critical Care, University of Alabama at Birmingham, Birmingham, AL, USA.
World J Pediatr Congenit Heart Surg. 2014 Oct;5(4):522-6. doi: 10.1177/2150135114550723.
Chylothorax complicates congenital heart disease (CHD) surgery and may be associated with significant morbidity. Etiology of chylothorax is multifactorial, and it has been associated with deep venous thrombosis and obstruction from central venous lines (CVLs) in patients without CHD. We sought to determine whether CVL insertion site was associated with the occurrence of chylothorax in infants after cardiac surgery.
Retrospective cohort of patients less than one year of age who underwent CHD surgery requiring cardiopulmonary bypass from 2008 to 2012. Chylothorax was identified by clinical diagnosis and/or laboratory findings (milky effusion, fluid with >100 mg/dL of triglycerides and/or >80% of lymphocytes). Central venous lines insertion site was verified by reviewing procedure notes and chest x-rays. Internal jugular (IJ), subclavian vein, and femoral vein (FV) CVLs were used during the study period.
Three hundred and ninety-two patients were included (mean age 97 days, mean weight 4.5 kg). Sixty-two (15.8%) of these patients developed chylothorax after surgery. Patients with chylothorax had longer bypass time (P=.02), longer cross-clamp time (P=.03), higher RACHS-1 category (P=.03), and more frequent upper body CVLs (IJ or subclavian vein; P=.03). There was no significant association with age, gender, preoperative weight, and height. Multivariate analysis showed patients with a CVL in the upper body (IJ or subclavian vein) were almost two times more likely to develop a chylothorax than patients who had FV CVL, (odds ratio=1.9, 95% confidence interval=1.05-5.60; P=.044).
Postoperative chylothorax is associated with line insertion in the upper body (subclavian vein and IJ). Avoidance of CVLs in these locations may decrease its incidence.
乳糜胸是先天性心脏病（CHD）手术的并发症，可能伴有严重的发病率。乳糜胸的病因是多因素的，在非CHD患者中，它与深静脉血栓形成及中心静脉导管（CVL）阻塞有关。我们试图确定CVL插入部位是否与心脏手术后婴儿乳糜胸的发生有关。
对2008年至2012年接受需要体外循环的CHD手术的1岁以下患者进行回顾性队列研究。通过临床诊断和/或实验室检查结果（乳状积液、甘油三酯>100mg/dL和/或淋巴细胞>80%的液体）确定乳糜胸。通过查阅手术记录和胸部X光片核实中心静脉导管插入部位。在研究期间使用了颈内静脉（IJ）、锁骨下静脉和股静脉（FV）CVL。
纳入392例患者（平均年龄97天，平均体重4.5kg）。其中62例（15.8%）患者术后发生乳糜胸。发生乳糜胸的患者体外循环时间更长（P=0.02）、主动脉阻断时间更长（P=0.03）、RACHS-1分级更高（P=0.03），且上身CVL（IJ或锁骨下静脉）使用更频繁（P=0.03）。与年龄、性别、术前体重和身高无显著关联。多因素分析显示，上身（IJ或锁骨下静脉）置入CVL的患者发生乳糜胸的可能性几乎是置入FV CVL患者的两倍（比值比=1.9，95%置信区间=1.05-5.60；P=0.044）。
术后乳糜胸与上身（锁骨下静脉和IJ）置管有关。避免在这些部位置入CVL可能会降低其发生率。
