心脏手术后强化恢复方案中第 1 天提前拔除胸腔引流管的安全性。

Early chest tube removal on the 1st postoperative day protocol of an enhanced recovery after cardiac surgery programme is safe.

机构信息

Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.

Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.

出版信息

Eur J Cardiothorac Surg. 2024 Mar 1;65(3). doi: 10.1093/ejcts/ezae092.

DOI:10.1093/ejcts/ezae092

PMID:38466938

Abstract

OBJECTIVES

The aim of this study was to assess the safety of early chest tube removal (CTR) protocol on the 1st postoperative day (POD1) of our Enhanced Recovery After Surgery (ERAS) programme by comparing the risk of postoperative pneumothorax, pleural and pericardial effusion requiring intervention and hospital mortality.

METHODS

All consecutive patients undergoing elective coronary revascularization and/or valve surgery between 2015 and 2021 were assessed in terms of their perioperative management pathways: conventional standard of care (control group) versus standardized systematic perioperative ERAS programme including an early CTR on POD1 (ERAS group). A propensity score matching was applied. The primary end-point was a composite of postoperative pneumothorax, pleural and pericardial effusion requiring intervention and hospital mortality.

RESULTS

A total of 3153 patients were included. Propensity score analysis resulted in 2 groups well-matched pairs of 1026 patients. CTR on POD1 was significantly increased from 29.5% in the control group to 70.3% in the ERAS group (P < 0.001). The incidence of the primary end-point was 6.4% in the control group and 6.9% in the ERAS group (P = 0.658). Patients in the ERAS group, as compared with control group, had significant lower incidence of bronchopneumonia (9.0% vs 13.5%; P = 0.001) and higher incidence of mechanical ventilation ≤6 h (84.6% vs 65.2%; P < 0.001), length of intensive care unit ≤1 day (61.2% vs 50.8%; P < 0.001) and hospital ≤6 days (67.3% vs.43.2%; P < 0.001).

CONCLUSIONS

CTR on POD1 protocol can be safely incorporated into a standardized systematic ERAS programme, enabling early mobilization, and contributing to the improvement of postoperative outcomes.

CLINICAL TRIAL REGISTRATION NUMBER

Ethics committee of the French Society of Thoracic and Cardio-Vascular Surgery (CERC-SFCTCV-2022-09-13_23140).

摘要

目的

本研究旨在通过比较术后气胸、需要干预的胸腔和心包积液以及住院死亡率，评估我们的加速康复外科（ERAS）方案中第 1 个术后日（POD1）早期拔管（CTR）方案的安全性。

方法

评估 2015 年至 2021 年间行择期冠状动脉血运重建和/或瓣膜手术的所有连续患者的围手术期管理途径：常规标准护理（对照组）与包括 POD1 早期 CTR 的标准化系统围手术期 ERAS 方案（ERAS 组）。应用倾向评分匹配。主要终点是包括需要干预的术后气胸、胸腔和心包积液以及住院死亡率的复合终点。

结果

共纳入 3153 例患者。倾向评分分析得出 2 组 1026 例配对患者匹配良好。对照组中 CTR 从 29.5%显著增加到 ERAS 组的 70.3%（P<0.001）。对照组和 ERAS 组的主要终点发生率分别为 6.4%和 6.9%（P=0.658）。与对照组相比，ERAS 组患者的支气管肺炎发生率显著降低（9.0% vs 13.5%；P=0.001），机械通气≤6 h 的发生率更高（84.6% vs 65.2%；P<0.001），重症监护病房≤1 天的发生率更高（61.2% vs 50.8%；P<0.001），住院时间≤6 天的发生率更高（67.3% vs.43.2%；P<0.001）。