Causes And Clinical Treatment Of Reoperation For Postoperative Bleeding After Cardiac Surgery

[Objective]To sum up clinical features of postoperative bleeding and cardiac tamponade after cardiac surgery and to explore its causes, prevention, treatment and the indications for reoperation.[Methods]The retrospective analysis on 87 reoperative cases of the Second Xiangya Hospital Cardiothoracic Surgery from June 2007 to April 2008 for postoperative bleeding and cardiac tamponade, gathering the related data and performing statistic analysis.[Results]We retrospectively analyzed and identified 21 cases of active bleeding, 63 cases of acute cardiac tamponade, 3 cases of delayed cardiac tamponade. 76 postoperative cases were discharged and 11 cases were death (3 cases of active bleeding , 8 cases of acute cardiac tamponade). In the postoperative bleeding group, Artery Systolic Blood Pressure (SABP), Artery Diastolic Blood Pressure (ADBP), Central Venous Pressure (CVP), Urine Volume (UV) all decreased significantly, both Heart Rate (HR) and drainage increased significantly (P <0.05), with the obvious fluctuations of water-column in drainage tube. In the postoperative acute cardiac tamponade group, pH, SABP, DABP decreased suddenly and quickly, UV reduced obviously, and CVP, HR increased rapidly (P <0.05). The water-column fluctuations in drainage tube disappeared and the drainage suddenly reduced. In the postoperative delayed cardiac tamponade group, PaO2 decreased, HR and CVP increased (P <0.05). The postoperative active bleeding chiefly presented in the incision of the heart and great vessels, thymus, periosteum and bone marrow cavity, Xiphoid vessels, pericardial margin, perforation of steel wires. And blood oozed diffusely from wound surface in 66 cases.[Conclusion]The chief causes of postoperative bleeding and cardiac tamponade after cardiac surgery include preoperative heart failure, secondary multiple organ dysfunction, disarrangement of clotting mechanism after cardiopulmonary bypass, incomplete stanching during the operation, incomplete neutralization of heparin and protamine, untimely postoperative care. And the key points of the prevention and treatment for postoperative bleeding include the preoperative adjustment of organ function, careful operation, complete stanch , reinforcement of the blood protection and postoperative care, proper handle, and if necessary, performing thoracotomy for hemostasis timely.