Shahzad Muhammad, Alheraish Yasser A, Beheri Reem M E, Algethami Bushra, Machado Patricia, Mohamed Gamal, Khouqeer Fared, Al Halees Zohair
Pediatric CSICU, King Faisal Specialist Hospital and Research Center, Riyadh, KSA.
Statistics Department, King Faisal Specialist Hospital and Research Center, Riyadh, KSA.
J Saudi Heart Assoc. 2023 Jun 30;35(2):169-176. doi: 10.37616/2212-5043.1341. eCollection 2023.
Risk factors for postoperative chylothorax in children who had cardiothoracic procedures are not always clear. Due to complex course in post-operative care, It's always challenging to find the risk factors, and their management.
The aim of our study was to identify the incidence, risk factors and effective treatment approaches for chylothorax after pediatric heart surgery.
Children who had the cardiac surgery and subsequently developed chylothorax were included in the study. The ratio of the experimental group to the control group was 1:2. Decannulations of extracorporeal membrane oxygenation (ECMO) were not included in the analysis of patient outcomes. For each patient, we keep track of their age, weight, gender, syndrome, RACH-1 scoring, fluid balance, bypass time, clamp time, redo operations, open or close heart surgeries, and rhythm difficulties. Care logs were kept for every single therapy that was administered. Primary outcome was chylothorax, with secondary outcomes included time in the intensive care unit (ICU), length of hospital stay (LOS), and death.
5210 surgeries were performed in six years. 96 patients developed the chylothorax with incidence of 1.8%. In chylothorax group, mean weight was 6.7 ± 4.2, while mean age was 11.7 ± 15.2. Clamp time was 74.5 ± 53.5 versus 39.9 ± 13.7. Mean bypass time was 128.34(76.25) versus 84.3 ± 25.1 with an odds ratio 1.02 (Z test 0.0001). Six (6.3%) children with chylothorax had redo cardiac surgeries in the same admission (p-value 0.01) while none in other. Five (5.2%) cases got operated by thoracotomy, three from left side. Mean Chest tube duration was 10±7.8 days versus 3.8±2.4 in control group. (p-value 0.02). chylothorax resolved (mean resolving time = 4 days) in 76 (79.2%) children with monogen formula. Two patients receive midodrine with no significant effect. Four children underwent surgical repair for chylothorax.
Bypass time linearly increases incidence of chylothorax. Younger age, low weight, syndromic children, redo operations, non-open-heart surgeries, and arrhythmias also contribute to this. Gender, fluid balance, and RACHS-1 Scoring were not significant. While further research and testing are required for the use of midodrine. However, the low-fat formula of Monogen has proven to be an effective treatment.
心胸手术患儿术后发生乳糜胸的危险因素并不总是明确的。由于术后护理过程复杂，寻找危险因素及其管理方法一直具有挑战性。
我们研究的目的是确定小儿心脏手术后乳糜胸的发生率、危险因素和有效的治疗方法。
本研究纳入了接受心脏手术并随后发生乳糜胸的患儿。实验组与对照组的比例为1:2。体外膜肺氧合（ECMO）脱机情况不纳入患者预后分析。对于每位患者，我们记录他们的年龄、体重、性别、综合征、RACH-1评分、液体平衡、体外循环时间、阻断时间、再次手术、心脏直视或非直视手术以及心律失常情况。对所给予的每一项治疗都进行护理记录。主要结局是乳糜胸，次要结局包括重症监护病房（ICU）住院时间、住院时长（LOS）和死亡。
六年内共进行了5210例手术。96例患者发生乳糜胸，发生率为1.8%。乳糜胸组的平均体重为6.7±4.2，平均年龄为11.7±15.2。阻断时间为74.5±53.5，而对照组为39.9±13.7。平均体外循环时间为128.34（76.25），而对照组为84.3±25.1，比值比为1.02（Z检验0.0001）。6例（6.3%）乳糜胸患儿在同一住院期间进行了再次心脏手术（p值0.01），而对照组无。5例（5.2%）患者接受了开胸手术，3例来自左侧。平均胸管留置时间为10±7.8天，而对照组为3.8±2.4天（p值0.02）。76例（79.2%）采用单源配方奶粉的患儿乳糜胸得到缓解（平均缓解时间 = 4天）。2例患者接受米多君治疗，效果不显著。4例患儿因乳糜胸接受了手术修复。
体外循环时间与乳糜胸发生率呈线性增加。年龄较小、体重低、患有综合征的患儿、再次手术、非心脏直视手术和心律失常也有影响。性别、液体平衡和RACHS-1评分无显著影响。虽然米多君的使用需要进一步研究和测试。然而，单源配方奶粉的低脂配方已被证明是一种有效的治疗方法。
