Kim Young Eun, Jung Hanna, Cho Joon Yong, Kim Yeo Hyang, Hyun Myung Chul, Lee Youngok
Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
Department of Pediatrics, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
Korean J Thorac Cardiovasc Surg. 2020 Feb;53(1):16-21. doi: 10.5090/kjtcs.2020.53.1.16. Epub 2020 Feb 5.
Patients undergoing cardiac surgery require postoperative chest drainage. However, the drain is difficult to keep in place in children with congenital heart disease. Since 2015, at Kyungpook National University Hospital, the chest tube is removed on postoperative day 1 in patients who have undergone simple congenital cardiac surgery (i.e., closure of an atrial or ventricular septal defect). In this study, we evaluated the relationship between the duration of drain placement and the likelihood of pericardial effusion after congenital cardiac surgery.
The medical records of patients who underwent closure of an atrial or ventricular septal defect at our hospital between January 2014 and December 2016 were reviewed. In total, 162 patients who received follow-up echocardiography and had information available on postoperative pericardial effusion after the repair procedure were enrolled.
Echocardiography was performed at a median of 5 days (range, 4 to 6 days) postoperatively before discharge from the hospital. Pericardial effusion occurred in 21 patients (13.0%), of whom only 3 (1.9%) had moderate or greater pericardial effusion, regardless of the drain duration. All patients improved during outpatient follow-up without invasive management. No patient had severe complications because of pericardial effusion. The duration of drain placement did not affect the incidence of postoperative pericardial effusion (p=0.069). Operative survival was 100%.
Based on our study, we recommend removing the drain as soon as its role is complete, generally on postoperative day 1, because early removal does not increase the incidence of pericardial effusion in patients undergoing simple congenital cardiac surgery.
接受心脏手术的患者术后需要进行胸腔引流。然而，先天性心脏病患儿的引流管很难固定在位。自2015年以来，在庆北国立大学医院，对于接受简单先天性心脏手术（即房间隔或室间隔缺损修补术）的患者，术后第1天即拔除胸管。在本研究中，我们评估了先天性心脏手术后引流管放置时间与心包积液发生可能性之间的关系。
回顾了2014年1月至2016年12月期间在我院接受房间隔或室间隔缺损修补术患者的病历。共有162例接受了随访超声心动图检查且有修补术后心包积液相关信息的患者纳入研究。
出院前术后中位5天（范围4至6天）进行了超声心动图检查。21例患者（13.0%）发生心包积液，其中仅3例（1.9%）有心包积液中度或以上，与引流时间无关。所有患者在门诊随访期间均有改善，无需进行有创处理。没有患者因心包积液出现严重并发症。引流管放置时间不影响术后心包积液的发生率（p = 0.069）。手术生存率为100%。
基于我们的研究，我们建议在引流管的作用完成后尽快拔除，一般在术后第1天，因为早期拔除不会增加接受简单先天性心脏手术患者心包积液的发生率。
