喷涂医用生物蛋白胶减少心包大部剥脱患者术后渗血

Bioglue reduces post-operative errhysis in patients undergoing pericardiectomy

目的:观察医用生物蛋白胶抑制慢性缩窄性心包炎患者术后渗血的疗效。方法:选择2005-03/2006-12在中国医科大学附属第一医院收治,全麻下正中开胸行心包大部剥脱术的慢性缩窄性心包炎患者48例,数字表法随机分成医用生物蛋白胶组和对照组2组,每组24例。两组手术方法相同,医用生物蛋白胶组在心脏创面渗血处及胸骨骨髓腔内喷涂生物蛋白胶(上海利康瑞生物工程有限公司提供),对照组常规涂抹医用骨蜡封闭胸骨。记录两组术后第1天引流量及总引流量、引流液血红蛋白质量浓度、拔引流管时间及平均住院时间,在术前、术后当天、术后3,7,14d动态监测中心静脉压。结果:48例患者均完成治疗和测试进入结果分析。①医用生物蛋白胶组引流量少于对照组[术后第1天:(191.32±30.73),(313.42±45.69)mL;总引流量:(360.83±71.82),(522.92±60.84)mL;P均<0.01];引流液血红蛋白质量浓度低于对照组[(116.00±9.29),(125.17±12.33)g/L,P=0.041]。②医用生物蛋白胶组拔引流管时间早于对照组[(41.67±5.99),(48.75±5.93)h,P=0.025];平均住院时间短于对照组[(14.67±1.07),(15.92±1.08)d,P=0.032]。③两组术后中心静脉压值无明显差异。④医用生物蛋白胶未发现不良副作用。结论:医用生物蛋白胶明显减少心包大部剥脱术后心脏创面及胸骨渗血,缩短平均住院时间,且使用安全。

AIM： To study the clinical effect of the bioglue in reducing the errhysis of the patients undergoing pericardiectomy. METHODS： The consecutive 48 patients with constrictive pericarditis were treated in the First Affiliated Hospital of China Medical University between March 2005 and December 2006, and were divided into bioglue group and control group randomly of 24 subjects in each. The wound surface of heart and medullary cavity of the sternum was utilized by bioglue （Shanghai Likory） and bone wax, respectively. The quantity of the drainage on the first day and total quantity, the concentration of hemoglobin in drain, the time of draining closure and the mean hospitalization time were recorded. Meanwhile the central venous pressure was examined. RESULTS： All 48 patients were involved in the result analysis. ①Compared with control group, the quantity of the drainage was lower in the bioglue group [on the first day post-operation： （191.32±30.73）, （313.42±45.69） mL; total quantity： （360.83±71.82）, （522.92±60.84） mL; P 〈 0.01]; the concentration of hemoglobin in drain were also lower in the bioglue group [（116.00±9.29）, （125.17±12.33） g/L, P =0.041].②The time of draining closure was earlier in the bioglue group than in control group [（41.67±5.99）, （48.75±5.93） h, P =0.025], and mean hospitalization time was reduced [（14.67±1.07）, （15.92±1.08） d, P =0.032].③There was no statistical difference of central venous pressure.④No adverse side effect was clinically observed in the bioglue group. CONCLUSION： Bioglue can evidently reduce the errhysis in wound surface of heart and medullary cavity of the sternum for the patients undergoing pericardiectomy, with shorter in-hospital time and higher safety.