Vargas F S, Cukier A, Hueb W, Teixeira L R, Light R W
Instituto do Coracao, Faculty of Medicine, University of Sao Paulo, Brazil.
Chest. 1994 Jun;105(6):1748-52. doi: 10.1378/chest.105.6.1748.
The explanation for the high incidence of pleural effusion after cardiac surgery is unclear. There is a high incidence of left pleural effusion with inflammatory pericardial disease. We hypothesized that after coronary artery bypass grafting (CABG) there would be a higher incidence of pleural effusions in patients with pericardial involvement. We prospectively studied 47 patients undergoing elective CABG; 17 had only saphenous vein grafts (SVG group) and 30 received at least one internal mammary artery graft (IMA group) in addition to SVG. Patients had a chest radiograph, chest ultrasound, and an echocardiogram on the 7th, 14th, and 30th postoperative days. Seven days after the surgery, 42 to 47 patients (89.4 percent) had a pleural effusion and 36 (76.6 76.6 percent) pericardial involvement. No relationship was found between the presence of a pleural effusion and a pericardial effusion (p > 0.05). On the 14th postoperative day, 36 patients (76.6 percent) had a pleural effusion while 33 patients (70.2 percent) had a pericardial effusion. There was a significant relationship between the presence of a pleural effusion and a pericardial effusion (p < 0.05). On the 30th postoperative day, 27 patients (57.4 percent) had a pleural effusion and 25 (53.2 percent) had a pericardial effusion. Again, there was a significant relationship between a pleural effusion and a pericardial effusion (p < 0.05). Finally, there was no relationship between the ejection fraction and the presence of pleural effusion at any time (p > 0.05). From this study, we conclude that there is a high prevalence of both pleural and pericardial effusion postoperatively in patients undergoing CABG. Both types of effusions tend to be asymptomatic, gradually disappear, and are more common in the IMA group. Patients who have a persistent pericardial effusion are more likely to have a persistent pleural effusion.
心脏手术后胸腔积液发生率高的原因尚不清楚。炎性心包疾病患者左胸腔积液的发生率较高。我们推测，冠状动脉旁路移植术（CABG）后，心包受累的患者胸腔积液的发生率会更高。我们对47例行择期CABG的患者进行了前瞻性研究；17例仅行大隐静脉移植（SVG组），30例除SVG外还接受了至少一根乳内动脉移植（IMA组）。患者在术后第7天、第14天和第30天进行胸部X线检查、胸部超声检查和超声心动图检查。术后7天，42至47例患者（89.4%）出现胸腔积液，36例（76.6%）有心包受累。未发现胸腔积液与心包积液之间存在关联（p>0.05）。术后第14天，36例患者（76.6%）出现胸腔积液，33例患者（70.2%）有心包积液。胸腔积液与心包积液之间存在显著关联（p<0.05）。术后第30天，27例患者（占57.4%）出现胸腔积液，25例（占53.2%）有心包积液。胸腔积液与心包积液之间再次存在显著关联（p<0.05）。最后，射血分数与任何时候胸腔积液的存在均无关联（p>0.05）。从这项研究中，我们得出结论，行CABG的患者术后胸腔和心包积液的发生率均较高。两种类型的积液往往无症状，会逐渐消失，且在IMA组中更常见。有心包积液持续存在的患者更有可能出现胸腔积液持续存在的情况。
