Manshanden Johan S J, Gielen Chantal L I, de Borgie Corianne A J M, Klautz Robert J M, de Mol Bas A J M, Koolbergen David R
Department of Cardiothoracic Surgery, Academic Medical Center (AMC), Amsterdam, The Netherlands.
Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
EBioMedicine. 2015 Jul 31;2(9):1217-23. doi: 10.1016/j.ebiom.2015.07.031. eCollection 2015 Sep.
Prolonged or excessive blood loss is a common complication after cardiac surgery. Blood remnants and clots, remaining in the pericardial space in spite of chest tube drainage, induce high fibrinolytic activity that may contribute to bleeding complications. Continuous postoperative pericardial flushing (CPPF) with an irrigation solution may reduce blood loss by preventing the accumulation of clots. In this pilot study, the safety and feasibility of CPPF were evaluated and the effect on blood loss and other related complications was investigated.
Between November 2011 and April 2012 twenty-one adult patients undergoing surgery for congenital heart disease (CHD) received CPPF from sternal closure up to 12 h postoperative. With an inflow Redivac drain that was inserted through one of the chest tube incision holes, an irrigation solution (NaCl 0.9% at 38 °C) was delivered to the pericardial cavity using a volume controlled flushing system. Safety aspects, feasibility issues and complications were registered. The mean actual blood loss in the CPPF group was compared to the mean of a retrospective group (n = 126).
CPPF was successfully completed in 20 (95.2%) patients, and no method related complications were observed. Feasibility was good in this experimental setting. Patients receiving CPPF showed a 30% (P = 0.038) decrease in mean actual blood loss 12 h postoperatively.
CPPF after cardiac surgery was found to be safe and feasible in this experimental setting. The clinically relevant effect on blood loss needs to be confirmed in a randomized clinical trial.
心脏手术后长时间或过度失血是一种常见并发症。尽管有胸管引流，但心包腔内残留的血液残渣和凝块会引发高纤溶活性，这可能导致出血并发症。用冲洗液进行术后持续心包冲洗（CPPF）可通过防止凝块积聚来减少失血。在这项前瞻性研究中，评估了CPPF的安全性和可行性，并研究了其对失血及其他相关并发症的影响。
2011年11月至2012年4月期间，21例接受先天性心脏病（CHD）手术的成年患者在胸骨闭合后至术后12小时接受了CPPF。通过胸管切口孔之一插入的流入式Redivac引流管，使用容量控制冲洗系统将冲洗液（38℃的0.9%氯化钠溶液）输送至心包腔。记录安全性、可行性问题及并发症。将CPPF组的平均实际失血量与回顾性组（n = 126）的平均值进行比较。
20例（95.2%）患者成功完成了CPPF，未观察到与方法相关的并发症。在该实验环境中可行性良好。接受CPPF的患者术后12小时平均实际失血量减少了30%（P = 0.038）。
在该实验环境中，心脏手术后的CPPF被发现是安全可行的。对失血的临床相关影响需要在随机临床试验中得到证实。
