Hunter S, Angelini G D
Department of Cardiac Surgery, University of Sheffield, United Kingdom.
Ann Thorac Surg. 1993 Dec;56(6):1339-42. doi: 10.1016/0003-4975(93)90678-b.
Occlusion of chest drainage tubes by thrombus is not uncommon after open heart operations. It has been suggested that by coating the tube with phosphatidylcholine (PC), the most prominent phospholipid in the erythrocytes outer membrane, it may be possible to overcome the blood-material interaction responsible for thrombus formation. To test this hypothesis 102 patients (75 males; mean age, 57 +/- 10 years) were randomly allocated to receive either PC-coated or noncoated 32F chest drainage tubes. Preoperative status, type and length of operation, and duration of drainage were similar in the two groups as was postoperative blood loss. Patients receiving PC-coated tubes, however, had less residual blood clot in the tube after removal (0.7 +/- 0.1 versus 3.1 +/- 0.3 g; p < 0.001), a reduced incidence of pericardial effusions (17.6% versus 41.2%; p < 0.01), fewer postoperative supraventricular arrhythmias (2 of 51 versus 10 of 51; p < 0.002), and a shorter hospital stay (8.4 +/- 0.3 versus 9.7 +/- 0.5 days; p < 0.05). Late cardiac tamponade developed in 2 patients in the noncoated group 6 and 10 days postoperatively, which required reexploration. The data show that PC-coated chest drainage tubes are less susceptible to occlusion by thrombus and their use is associated with a significant reduction in postoperative morbidity.
心脏直视手术后，血栓堵塞胸腔引流管的情况并不少见。有人提出，通过用磷脂酰胆碱（PC，红细胞外膜中最主要的磷脂）包覆引流管，或许有可能克服导致血栓形成的血液与材料间的相互作用。为验证这一假设，102例患者（75例男性；平均年龄57±10岁）被随机分配，分别接受PC包覆或未包覆的32F胸腔引流管。两组患者的术前状况、手术类型和时长、引流持续时间以及术后失血量均相似。然而，接受PC包覆引流管的患者，拔除引流管后管内残留血凝块较少（0.7±0.1克对3.1±0.3克；p<0.001），心包积液发生率降低（17.6%对41.2%；p<0.01），术后室上性心律失常较少（51例中有2例对51例中有10例；p<0.002），住院时间较短（8.4±0.3天对9.7±0.5天；p<0.05）。未包覆引流管组有2例患者在术后6天和10天发生迟发性心脏压塞，需要再次开胸探查。数据表明，PC包覆的胸腔引流管较不易被血栓堵塞，使用这种引流管可显著降低术后发病率。
