ﻣﻘﺎﻳﺴﺔ درﻧﺎژ ﺣﻔﺮة ﭘﺮﻳﻜﺎرد و ﭘﻠﻮر ﭘﺲ از اﻋﻤﺎل ﺟﺮاﺣﻲ ﻗﻠﺐ ﺑﺎز ﺑﺎ دو روش ﺗﻮراﻛﻮﺳﺘﻮﻣﻲ از ﻟﺘﺮال و ﻣﺪﻳﺎل در ﺑﻴﻤﺎرﺳﺘﺎن ﺷﺮﻳﻌﺘﻲ در ﺳﺎل 1377

Comparison of Pleural and Pericardial Drainage with Medial or Lateral Thoracostomy Drain in Shariati Hospital in 1998-1999

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺗﺨﻠﻴﺔ ﻛﺎﻣﻞ ﺧﻮﻥ ﻭ ﻣﺎﻳﻊ ﺣﻔـﺮﺓ ﭘﺮﻳﻜﺎﺭﺩ ﻭ ﭘﻠﻮﺭ ﺍﺯ ﺍﻳﻦ ﻧﻈﺮ ﺣﺎﺋﺰ ﺍﻫﻤﻴﺖ ﺍﺳﺖ ﻛﻪ ﺧﻮﻥ ﺑﺎﻗﻴﻤﺎﻧﺪﻩ ﭘﺲ ﺍﺯ ﻋﻤﻞ ﺑﻪ ﺻﻮﺭﺕ ﻣﺴﺘﻘﻴﻢ ﻳﺎ ﻏﻴﺮ ﻣﺴﺘﻘﻴﻢ ﺑﺎﻋﺚ ﻣﻮﺭﺗﺎﻟﻴﺘﻲ ﻭ ﻣـﻮﺭﺑﻴﺪﻳﺘﻲ ﭘﺲ ﺍﺯ ﻋﻤﻞ ﻣﻲ ﺷﻮﺩ. ﻫﺪﻑ ﺍﺯ ﺍﻳﻦ ﭘﮋﻭﻫﺶ، ﺍﺭﺍﺋﻪ ﺑﻬﺘﺮﻳﻦ ﺭﻭﺵ ﺟﻬﺖ ﺗﺨﻠﻴﻪ ﺣﻔﺮﺍﺕ ﭘﺮﻳﻜﺎﺭﺩ ﻭ ﭘﻠﻮﺭ، ﭘﺲ ﺍﺯ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﻗﻠﺐ ﺑﺎﺯ ﻣﻲ ﺑﺎﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﺍﻳﻦ ﺗﺤﻘﻴﻖ ﻛﻪ ﺑﺮ ﺭﻭﻱ 415 ﺑﻴﻤـﺎﺭ ﺗﺤﺖ ﻋﻤﻞ ﺟـﺮﺍﺣﻲ ﻗﻠﺐ ﺑﺎﺯ ﺩﺭ ﺑﺨﺶ ﺟﺮﺍﺣﻲ ﻗﻠﺐ ﺷﺮﻳﻌﺘﻲ ﺩﺭ ﺳﺎﻝ 1377 ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﺍﺳﺖ. ﻧﺘﺎﻳﺞ ﺭﺍﺩﻳﻮﮔـﺮﺍﻓﻲ ﻭ ﺗﺠﻤﻊ ﻣﺎﻳﻊ ﭘﺮﻳﻜﺎﺭﺩ ﻭ ﭘﻠـﻮﺭﺍﻝ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﺤﻞ ﻗﺮﺍﺭﮔﻴﺮﻱ ﺩﺭﻥ )ﮔﺮﻭﻩ ﻣﺪﻳﺎﻝ ﻭ ﻟﺘـﺮﺍﻝ( ﻭ ﺍﻧﺠﺎﻡ ﭘﺮﻳﻜﺎﺭﺩﻳـﻮﺗﻮﻣﯽ ﺧﻠﻔﻲ )ﮔﺮﻭﻩ ﺍﻟﻒ، ﺏ، ﺝ ﻭ ﺩ( ﺑﺮﺭﺳﻲ ﻭ ﻣﻘﺎﻳﺴﻪ ﺷﺪﻩ ﻭ ﻧﺘﺎﻳﺞ ﺫﻳﻞ ﺣﺎﺻﻞ ﮔﺸﺘﻪ ﺍﺳﺖ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺩﺭ21/7 ﺩﺭﺻﺪ ﺑﻴﻤﺎﺭﺍﻥ ﺩﺭ ﺭﻭﺯ ﺳﻮﻡ ﻭ ﺩﺭ 17/9 ﺩﺭﺻﺪ ﺑﻴﻤﺎﺭﺍﻥ ﺩﺭ ﻣﻮﻗﻊ ﺗﺮﺧﻴﺺ ﭘﺲ ﺍﺯ ﻋﻤﻞ ﺟﺮﺍﺣﯽ ﻗﻠﺐ ﺑﺎﺯ ﺩﺭﺟﺎﺗﯽ ﺍﺯ ﺗﺠﻤﻊ ﻣﺎﻳﻊ ﺩﺭ ﺣﻔﺮﻩ ﺟﻨﺒﻲ ﺩﺭ ﺭﺍﺩﻳﻮﮔـﺮﺍﻓﻲ ﺳﺎﺩﺓ ﺳﻴﻨﻪ ﻭﺟﻮﺩ ﺩﺍﺷﺘﻪ ﺍﺳﺖ. ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺩﺭﻥ ﻟﺘﺮﺍﻝ ﭼﻪ ﺑﺎ ﭘﺮﻳﮑﺎﺭﺩﻳﻮﺗﻮﻣﯽ ﺧﻠﻔﯽ ﻭ ﭼﻪ ﺑﺪﻭﻥ ﺁﻥ ﺩﺭ ﮐﺎﻫﺶ ﺷﻴﻮﻉ ﺗﺠﻤـﻊ ﻣﺎﻳﻊ ﺩﺭ ﺣﻔﺮﺓ ﺟﻨﺒﻲ ﭼﭗ ﺩﺭ ﺭﻭﺯ ﺳﻮﻡ ) 0/02 =P-value( ﻭ ﻣﻮﻗﻊ ﺗﺮﺧﻴﺺ )0/0001 =P-value( ﺍﺧﺘﻼﻑ ﻣﻌﻨﯽ ﺩﺍﺭﯼ ﺑﺎ ﮔﺮﻭﻩ ﺩﺭﻥ ﻓﻘﻂ ﻣـﺪﻳﺎﻝ ﺩﺍﺷﺘﻪ ﺍﺳﺖ. ﻣﻴﺰﺍﻥ ﺗﺠـﻤﻊ ﻣﺎﻳﻊ ﺩﺍﺧﻞ ﭘﺮﻳﻜﺎﺭﺩﻳﻮﻡ ﺩﺭ ﺍﮐﻮﮐﺎﺭﺩﻳﻮﮔﺮﺍﻓﯽ ﺩﺭ ﺍﻳﻦ ﮔﺮﻭﻩ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﺗﺤﺖ ﺑﺮﺭﺳﯽ 32/2 ﺩﺭﺻﺪ ﺑﻮﺩﻩ ﺍﺳﺖ. ﺍﺯ ﻧﻈﺮ ﺁﻣﺎﺭﻱ ﺗﺠـﻤﻊ ﻣﺎﻳﻊ ﺩﺍﺧﻞ ﭘﺮﻳﻜﺎﺭﺩﻳﻮﻡ ﺩﺭ ﻣﻮﻗﻊ ﺗﺮﺧﻴﺺ ﺑﻴﻦ ﮔﺮﻭﻩ ﻫﺎﯼ ﺍﻟﻒ، ﺏ، ﺝ ﻭ ﺩ ﺍﺧﺘﻼﻑ ﻗﺎﺑﻞ ﺗﻮﺟﻬﻲ ﺑﺎ ﻫﻢ ﺩﺍﺷﺘﻨﺪ )0/0001 =P-value(. ﻳﻌﻨﯽ ﺗﺠـﻤﻊ ﻣﺎﻳﻊ ﺩﺍﺧﻞ ﭘﺮﻳﻜﺎﺭﺩﻳﻮﻡ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺎ ﭘﺮﻳﮑﺎﺭﺩﻳﻮﺗﻮﻣﯽ ﺧﻠﻔﯽ ﮐﻤﺘﺮ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺪﻭﻥ ﺁﻥ ﺍﺳﺖ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺑﺮ ﻃﺒﻖ ﺍﻳﻦ ﭘﮋﻭﻫﺶ، ﺩﺭ ﺑﻴﻤﺎﺭﺍﻧﻲ ﮐﻪ ﺗﺤﺖ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﻗﻠﺐ ﺑﺎﺯ ﻗﺮﺍﺭ ﻣﻲ ﮔﻴﺮﻧﺪ، ﺩﺭ ﺻﻮﺭﺕ ﺑﺎﺯ ﺷﺪﻥ ﻓﻀﺎﯼ ﺟﻨﺒﻲ ﻣﻲ ﺑﺎﻳﺴﺖ ﺩﺭﻧﺎﮊ ﺍﺯ ﻃﺮﻳﻖ ﺩﺭﻥ ﻟﺘﺮﺍﻝ ﺍﻧﺠﺎﻡ ﮔﻴﺮﺩ. ﻫﻤﭽﻨﻴﻦ ﭘﺮﻳﮑﺎﺭﺩﻳﻮﺗﻮﻣﻲ ﺧﻠﻔﻲ ﻧﻴﺰ ﺑﺎﻳﺪ ﺟﻬﺖ ﺑﻴﻤﺎﺭ ﺍﻧﺠﺎﻡ ﺷﻮﺩ.

ntroduction & Objective: Complete drainage of fluid and blood from pericardial and pleural cavity after cardiac surgery is very important because the residual blood, directly or indirectly, increases morbidity or mortality. The main goal of this study was to find the best method of pericardial and pleural drainage after cardiac surgery. Materials & Methods: This study was performed in 415 patients undergoing open heart surgery in Shariati Hospital between April 1998 and March 1999. Radiological findings and pericardial and pleural effusion in terms of the drain sites and in terms of posterior pericardiotomy (groups A, B, C and D) were analyzed and evaluated in these patients. Results: In 21.7% of the patients on the 3rd postoperative day, and in 17.9% of the patients on the 7th postoperative day, pleural effusion was seen. The lateral drain with or without posterior pericardiotomy significantly reduced pleural effusion on the 3rd (p-value = 0.02) and 7th (p-value=0.0001) postoperative days in comparison with the median drain. Pericardial effusion in this study was 32.2%, whereas the drain site did not affect pericardial effusion, posterior pericardiotomy affected and reduced pericardial effusion. There was significant difference (P-value = 0.0001) in terms of pericardial effusion between groups A, B, C and D. Conclusions: This study shows the better outcome of posterior pericardiotomy and lateral (direct) drainage of pleural cavity. In patients undergoing open heart surgery, if either of the pleural spaces is opened, we recommend that a drain be directly inserted into that space laterally and that posterior pericardiotomy be also performed for them.