Predictors of prolonged drainage of chylothorax after cardiac surgery: single centre study
Predictors of prolonged drainage of chylothorax after cardiac surgery: single centre study
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DOI：
10.1007/s00383-011-2890-8
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发表时间：
2011-08-01
影响因子：
1.8
通讯作者：
Sersar, Sameh Ibrahim
中科院分区：
文献类型：
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作者：
Sersar, Sameh Ibrahim
乳糜胸是一个临床挑战。本研究旨在确定沙特阿拉伯吉达一家三级中心心脏手术后乳糜胸引流时间延长的预测因素。回顾性分析了52例心脏手术后发生乳糜胸的患者（2007年1月至2010年9月），平均年龄为30个月（范围1个月至60岁）。收集了患者的人口统计学资料、手术方法、乳糜引流及其处理、并发症和随访情况。所有患者均采用无脂饮食或Monogen治疗。8例患者（15.4%）使用了单独的无脂饮食和类固醇。7例（13.5%）患者同时使用生长抑素类似物奥曲肽，2例（3.8%）患者同时使用类固醇和奥曲肽。胸管引流的中位持续时间为10.5天（范围4-34天）。胸管引流量中位数/kg/天为18 mL（范围6.6-72 mL）。除1例需行胸导管结扎术和1例死亡外，所有患者均对药物治疗有反应。奥曲肽和类固醇激素的应用显著减少了胸管引流量。出院后平均随访12个月（范围1-40个月），未观察到乳糜胸复发。乳糜胸在小儿心脏手术后比成人心脏手术后更常见。心脏手术后乳糜胸的保守治疗仍然是标准方法。类固醇和/或奥曲肽可以使用一个可接受的成功。乳糜胸胸管引流时间延长的最重要预测因素是甘油三酯/胆固醇比值大于2。
Chylothorax is a clinical challenge. This study aims at determination of the predictors of prolonged drainage of chylothorax after cardiac surgery in a single tertiary centre in Jeddah, Saudi Arabia.A retrospective analysis of 52 patients of chylothorax with a mean age of 30 months (range 1 month to 60 years) who developed chylothorax after heart surgery (January 2007-September 2010). Data were collected regarding patients demographics, procedures, chylous drainage and its management, complications and follow-up.There was one hospital mortality. All patients were managed by fat-free diet or Monogen. Lone fat-free diet with steroids were used a in eight patients (15.4%). Somatostatin analogue (Octreotide) was used adjunctively in 7 (13.5%) patients and in two patients (3.8%), steroids and octreotide were used adjunctively. The median duration of chest tube drainage was 10.5 days (range 4-34 days). The median amount of chest tube drainage/kg/day was 18 mL (range 6.6-72 mL). All patients responded to medical treatment except one case who required thoracic duct ligation and a patient who died. The use of octreotide and steroids therapy significantly reduced the amount chest tube drainage. At median follow-up of 12 months (range 1-40 months) after hospital discharge, no recurrence of chylothorax was observed.Chylothorax is much more common post-pediatric cardiac than post-adult cardiac surgery. Conservative therapy of chylothorax after cardiac surgery remains the standard approach. Steroids and or octreotide can be used with an acceptable success. The most significant predictor of prolonged chest tube drainage in chylothorax is triglyceride/cholesterol ratio more than 2.