Duncan D A, Yaacobi Y, Goldberg E P, Mines M, O'Brien D, Congdon F, Carmichael M J
Department of Surgery, University of Florida, Gainesville 32610.
J Surg Res. 1988 Jul;45(1):44-9. doi: 10.1016/0022-4804(88)90019-4.
Pericardial adhesions subject patients requiring cardiac reoperation to potential injuries of the heart, great vessels, and extracardiac grafts during resternotomy. We evaluated polyvinylpyrrolidone (PVP) and a methlycellulose derivative (MCD) as intraoperative irrigating solutions in the prevention of postoperative pericardial adhesions. Fifteen dogs weighing 15 to 20 kg were divided into three equal cohorts and subjected to left thoracotomy with pericardiotomy. Prior to surgical manipulation, the pericardial cavity was irrigated with either PVP, MCD, or Ringer's lactate (RL). Serosal injury stimulating intraoperative trauma was induced by gauze sponge abrasion of the epicardium and inner surface of the pericardium and by allowing desiccation of serosal surfaces for 30 min. The pericardial cavity was evaluated for adhesion formation 6 weeks postoperatively by reoperation. Two independent observers, unaware of the study solution, evaluated the extent and severity of pericardial adhesions on a 0-4 scale. All dogs in the RL control group had surgically significant adhesions and a mean adhesion score of 3.2 +/- 1.1. In contrast, no PVP- or MCD-treated dog had surgically significant adhesions. The mean adhesion scores were 0.2 +/- 0.4 for PVP and 0.5 +/- 0.7 for MCD. Our results indicate that PVP (P less than 0.004) and MCD (P less than 0.024) significantly reduce pericardial adhesion formation when compared to RL. Clinical application of PVP or MCD for the prevention of pericardial adhesions should reduce morbidity and mortality of cardiac reoperation.
心包粘连会使需要再次进行心脏手术的患者在再次胸骨切开术期间面临心脏、大血管和心外移植物受到潜在损伤的风险。我们评估了聚乙烯吡咯烷酮（PVP）和一种甲基纤维素衍生物（MCD）作为术中冲洗液在预防术后心包粘连方面的效果。将15只体重在15至20千克之间的狗分成三组，每组数量相等，进行左胸切开术并心包切开术。在手术操作前，心包腔内分别用PVP、MCD或乳酸林格氏液（RL）进行冲洗。通过用纱布海绵擦伤心外膜和心包内表面以及使浆膜表面干燥30分钟来诱导刺激术中创伤的浆膜损伤。术后6周通过再次手术评估心包腔内粘连的形成情况。两名不了解研究溶液的独立观察者以0至4分的评分标准评估心包粘连的程度和严重程度。RL对照组的所有狗都有手术意义上的粘连，平均粘连评分为3.2±1.1。相比之下，接受PVP或MCD治疗的狗没有手术意义上的粘连。PVP组的平均粘连评分为0.2±0.4，MCD组为0.5±0.7。我们的结果表明，与RL相比，PVP（P＜0.004）和MCD（P＜0.024）能显著减少心包粘连的形成。PVP或MCD在预防心包粘连方面的临床应用应能降低心脏再次手术的发病率和死亡率。
