a Department of Cardio-Thoracic Surgery , Tampere University Heart Hospital , Tampere , Finland.
b Division of Vascular Surgery, Department of Surgery , Tampere University Hospital , Tampere , Finland.
Scand Cardiovasc J. 2019 Apr;53(2):104-109. doi: 10.1080/14017431.2019.1590630. Epub 2019 Apr 8.
To ascertain whether extended chest tube drainage decreases the occurrence of late tamponade after cardiac surgery.
All patients undergoing cardiac surgery at the Tampere University Heart Hospital, Tampere, Finland, between the 23 of October 2015 and the 17 of August 2016 were included. The first 260 consecutive patients were treated according to a short drainage protocol, in which the mediastinal chest tubes were removed during the first postoperative day unless producing >50ml/h, and the following 224 consecutive patients by an extended drainage protocol, in which the mediastinal chest tubes were kept at least until the second postoperative day, and thereafter if producing >50ml/4h. The incidence of late tamponade and the length and course of postoperative hospitalization, including the development of complications, were compared.
The occurrence of late cardiac tamponade was 8.8% following the short drainage protocol and 3.6% after the extended drainage protocol, p = .018. There were no statistically significant differences in the demographics, medical history, or the procedures performed between the study groups. The in-hospital mortality rate was 3.5%, the stroke rate was 2.1%, and the deep sternal wound infection rate was 1.7%, with no statistically significant differences between the groups. There were no differences in the need for reoperations for bleeding, infection rate, need for pleurocentesis, occurrence of atrial fibrillation, or the length of hospitalization between the groups.
Longer mediastinal chest tube drainage after cardiac surgery is associated with a significantly lower incidence of late cardiac tamponade.
确定延长胸腔引流管是否会降低心脏手术后迟发性心脏压塞的发生。
所有于 2015 年 10 月 23 日至 2016 年 8 月 17 日期间在芬兰坦佩雷大学心脏医院接受心脏手术的患者均纳入本研究。前 260 例连续患者根据短期引流方案进行治疗，其中纵隔胸腔引流管在术后第 1 天除非引流量>50ml/h，否则予以拔除，随后 224 例连续患者采用延长引流方案，即纵隔胸腔引流管至少保留至术后第 2 天，如果此后每 4 小时引流量>50ml，则保留引流管。比较两组迟发性心脏压塞的发生率以及术后住院时间和过程（包括并发症的发生）。
短期引流方案组迟发性心脏压塞的发生率为 8.8%，而延长引流方案组为 3.6%，p=0.018。两组患者的人口统计学、病史或手术方式均无统计学差异。院内死亡率为 3.5%，脑卒中发生率为 2.1%，深部胸骨伤口感染率为 1.7%，两组间无统计学差异。两组间因出血再次手术、感染率、需要胸腔穿刺、心房颤动发生率或住院时间均无差异。
心脏手术后延长纵隔胸腔引流管与迟发性心脏压塞发生率显著降低相关。
