مقايسه فراواني پريكارديال افيوژن و تامپوناد پس از عمل جراحي قلب با و بدون ساكشن Chest tube در بيماران مراجعه كننده به بيمارستان چمران اصفهان

Comparison of the prevalence of pericardial effusion and cardiac tamponade after cardiac surgery with and without chest tube suction in patients referred to Chamran hospital, Isfahan

پريكارديال افيوژن يكي از مهمترين عوارض اعمال جراحي قلب مي باشد. اتصال Chest tube تعبيه شده در مدياستن يا پلور بيماران به دستگاه ساكشن براي تخليه بهتر و مداوم ترشحات پريكارد يا پلور پس از اتمام جراحي، از جمله مباحث مهم در تكنيك هاي جراحي است كه مي تواند در ميزان تخليه ترشحات در بيماران و در نتيجه ميزان Outcome جراحي در اين بيماران تفاوت ايجاد كند. روش بررسي در اين مطالعه كارآزمايي باليني كه از فروردين 1396تا اسفند 1397در بيمارستان چمران شهر اصفهان انجام گرفته است تعداد 91 بيمار كانديد اعمال جراحي قلب وارد مطالعه شدند. بيماران تحت دو گروه اتصال Chest tube به ساكشن و بدون ساكشن تقسيم شدند. اطلاعات مربوط به طول مدت جراحي، مدت اينتوبيشن، فراواني پريكارديال افيوژن و تامپوناد در اين بيماران جمع آوري شد و تحت تجزيه و تحليل آماري قرار گرفت. ﺎﻓﺘﻪﻫﺎ: در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎن داده ﺷﺪ ﮐﻪ ﻓﺮاواﻧﯽ ﭘﺮﯾﮑﺎرﯾﺎل اﻓﯿﻮژن در ﮔــﺮوه ﺑــﺎ ﺳﺎﮐﺸــﻦ ﺑﻪﺻــﻮرت ﻣﻌﻨــﺎداري ﮐﻤﺘــﺮ از ﺑﺪون ﺳﺎﮐﺸﻦ ﺑﻮد )0/01=P(. ﻫﻤﭽﻨﯿﻦ ﻓﺮاواﻧﯽ ﺗﺎﻣﭙﻮﻧﺎد ﻧﯿﺰ در ﮔﺮوه ﺑﺎ ﺳﺎﮐﺸــﻦ ﺑﻪﺻــﻮرت ﻣﻌﻨــﺎداري ﮐﻤﺘــﺮ ﺑــﻮده اﺳــﺖ )0/04=P(. ﻫﻤﭽﻨﯿﻦ ﻃﻮل زﻣﺎن اﯾﻨﺘﻮﺑﺎﺳﯿﻮن ﺑﯿﻤﺎران ﭘﺲ از ﻋﻤﻞ ﺟﺮاﺣﯽ در ICU ﺑﻪ ﺷﮑﻞ ﻣﻌﻨﺎداري در ﮔﺮوه ﺑﺎ ﺳﺎﮐﺸــﻦﮐﻤﺘﺮ ﺑﻮده اﺳﺖ )0/001

Pericardial effusion is one of the most important complications of cardiac surgeries. Administration of a low-power suction to the mediastinal or pleural chest tube of patients helps better and constant drainage of pericardial or pleural secretions after surgeries. This technique might change the secretion and discharges of patients and might change the outcomes of surgeries. Methods This clinical trial was performed in 2017-2018 from April to March in Chamran Hospital of Isfahan on 91 patients who were candidates of cardiac surgeries. Patients are selected according to inclusion and exclusion criteria and finally, the study population is formed. In all patients after cardiac surgery, two Chest tubes were inserted, either in pericardial space or one in pericardia space and the other in left or right pleural space. After inserting chest tubes in patients and after sutures, patients were divided into two groups. In the first group, their chest tube was attached to the low power suctioning device, which resulted in active blood withdrawal or discharge of the site of surgery, the second group was also treated normally without binding to the suction device. The diagnosis of pericardial effusion or tamponade in patients who were hospitalized was made by clinical symptoms, portable chest graph as well as echocardiography, and in patients who had been discharged it was diagnosed by being referred to a specialist, clinical symptoms, chest radiography as well as echocardiography. Data regarding surgery duration, intubation duration, the prevalence of pericardial effusion, and cardiac tamponade were collected and analyzed. Results Administration of a low-pressure suction to the chest tube of patients was associated with decreased frequency of pericardial effusion (P=0.01). The frequency of tamponade was also significantly lower in patients with suction on chest tubes (P=0.04). Duration of intubation after ICU admission of patients was significantly lower in patients with suctions (P<0.001). Conclusion Generally, we indicated that the use of suction in cardiac surgeries is associated with decreased intubation time and of course decreased recovery time and decreased pericardial effusion. Therefore, this method could be used in cardiac surgeries.