右侧腋下直切口体外循环术后不留置胸腔引流管在先心病快速康复外科中的应用

Application of thoracic drainage tube without indwelling after cardiopulmonary bypass with right axillary straight incision in rapid rehabilitation surgery of congenital heart disease

目的评估右侧腋下直切口体外循环术后不留置胸腔引流管的安全性和可行性。方法回顾性分析西北妇女童医院2019年1月至2020年6月行右侧腋下直切口体外循环手术治疗简单先心病71例患儿的临床资料,按照术后是否留置胸腔引流管分为无管组(35例)和有管组(36例)。比较两组患儿的手术相关指标(体外循环时间、主动脉阻断时间、术中出血量、切口愈合情况)、术后机械通气时间、ICU滞留时间、总住院时间、术后镇痛镇静药用量及术后并发症发生情况。结果无管组患儿的术后镇痛镇静药用量、术后ICU滞留时间和术后总住院时间明显低(少)于有管组,差异均有统计学意义(P<0.05);两组患儿的体外循环时间、主动脉阻断时间、术中出血量及术后机械通气时间比较差异均无统计学意义(P>0.05);两组患儿在术后肺部感染、胸腔积气、胸腔积液、肺不张、胸腔穿刺、再置管引流方面比较差异均无统计学意义(P>0.05);两组患儿切口均甲级愈合、均无胸腔感染;所有患者均通过门诊行心电图、心脏超声、胸部X线检查随访6个月,未见心律失常、残余分流、肺炎及胸腔积液并发症,均对切口的美观性满意。结论经右侧腋下直切口体外循环的简单先心病手术患儿中采用术后不留置胸腔引流管技术,可减轻患儿疼痛烦躁、缩短术后住院时间,利于患儿快速康复;术后并发症发生可控,安全可行。

Objective To evaluate the safety and feasibility of thoracic drainage tube without indwelling after cardiopulmonary bypass with right axillary straight incision.Methods The clinical data of 71 children with simple congenital heart disease who underwent cardiopulmonary bypass with right subaxillary straight incision in Northwest Women’s and Children’s Hospital from January 2019 to June 2020 were retrospectively analyzed.According to whether to retain thoracic drainage tube after operation,the patients were divided into non-tube group(35 cases)and tube group(36 cases).The indicators related to the operation were compared between the two groups,including cardiopulmonary bypass time,aortic cross-clamping time,intraoperative blood loss,healing of incision,postoperative mechanical ventilation time and ICU stay time,the total length of hospital stay,postoperative analgesia dosage of sedatives,and postoperative complications.Results The amount of postoperative analgesics and sedatives,postoperative ICU retention time,and postoperative total hospitalization time in the non-tube group were significantly lower than those in the tube group(P<0.05).There were no significant differences in cardiopulmonary bypass time,aortic cross-clamping time,intraoperative blood loss,and postoperative mechanical ventilation time between the two groups(P>0.05).There were no significant differences in postoperative pulmonary infection,pleural pneumatocele,pleural effusion,atelectasis,pleural puncture and replacement of catheter drainage between the two groups(P>0.05).The incision in both groups was Grade A healing,and no chest infection was found.All patients were followed up for 6 months through outpatient ECG,echocardiography and chest X-ray examination,and no arrhythmia,residual shunt,pneumonia and pleural effusion complications were found.All patients were satisfied with the aesthetic appearance of the incision.Conclusion The technique of intrathoracic drainage tube without indwelling after operation in children with simple congenital heart disease undergoing cardiopulmonary bypass through right axillary straight incision can reduce pain and irritability,shorten the length of postoperative hospital stay,and facilitate rapid recovery of children.The postoperative complications were controllable,safe and feasible.