冠脉搭桥术中留置左侧胸腔引流管经验总结  

Experience of the Left Thoracic Drainage Tube Indwelling during Coronary Artery Bypass Grafting

作　　者：陈甜甜 王维铁 孙玉荣[1] 王凯[1] 孔祥荣[1] 霍明[2] CHEN Tian-tian;WANG Wei-tie;SUN Yu-rong;WANG Kai;KONG Xiang-rong;HUO Ming(Department of Cardiovascular Surgery,Tianjin First Central Hospital,Tianjin300192,China;Department of Cardio- vascular Surgery,the Second Hospital of Jilin University,Changchun 130000,Jilin,China)

机构地区：[1]天津市第一中心医院心脏外科,天津300192 [2]吉林大学第二医院心血管外科心血管外科,长春130000

出　　处：《中国现代手术学杂志》2019年第2期131-134,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的总结冠状动脉旁路移植术( coronary artery bypass grafting,CABG)术中左侧胸膜破裂患者留置胸腔引流管的经验。方法回顾性分析 2014 年 1 月~ 2017 年 7 月收治的体外循环下 CABG患者,选取肋膈角处留置橡胶引流管患者 42 例作为橡胶管组,肋膈角处留置硅胶引流管患者 41 例作为硅胶管组,左侧胸膜破裂单纯胸膜缝合患者 78 例作为未置管组。比较 3 组术中及术后相关临床指标的差异。结果全部患者住院期间无死亡。3 组患者在术后最低血氧分压、气管插管时间、监护室停留时间上差异显著( P<0.001);三组在胸片检查超过 5 次、胸腔积液彩超检查、胸腔穿刺、胸闷气短、呼吸困难及左胸疼痛的发生率上存在统计学差异( P<0.05);橡胶管组在胸片检查超过 5 次发生率和引流管口疼痛VAS 上优于硅胶管组(均 P<0.05);术后二氧化碳分压、胸腔引流液总量、皮下气肿、伤口愈合不良、肺不张并发症发生率 3 组比较无明显差异(均 P>0.05)。结论冠脉搭桥术中左侧胸膜破裂后留置橡胶引流管较为安全,能有效减少术后左侧胸腔积液发生率,减少患者疼痛感,有一定的临床意义。Objective To summarize the experience of the left thoracic drainage tube indwelling in pa- tients with left pleural rupture during coronary artery bypass grafting ( CABG). Methods A retrospective analysis of CABG patients under cardiopulmonary bypass from January 2014 to July 2017 was made. There were 42 patients with rubber drainage tube at costal diaphragmatic angle were selected as group A,and 41 patients with silicone drainage tube were selected as group B,and 78 patients with simple pleural suture were selected as the control group. The intraoperative and postoperative related indicators were compared. Results It was found significant differences in the lowest partial pressure of blood oxygen,tracheal intubation time,postoper- ative ICU stay,the incidence of chest X-ray examination more than 5 times,Doppler ultrasound examinations for pleural effusion,thoracic puncture,chest tightness and dyspnea and left chest pain among the three groups ( P<0.05). There were differences in the incidence of more than 5 chest radiographs and VAS of drainage orifice pain between group A and group B ( P<0.05). No significant difference was found in partial pressure of carbon dioxide and the incidence of closed thoracic drainage and the complications( such as subcutaneous em- physema,poor wound healing and atelectasis) among the three groups ( P>0.05). Conclusion It is safe to retain rubber drainage tubes after rupture of left pleura during CABG with advantages of less left pleural effusion and pain.

关 键 词：胸腔引流管 冠状动脉旁路移植术 体外循环 胸腔积液 胸腔穿刺 

分 类 号：R654.28[医药卫生—外科学]