The Effects Of Spraying Thrombin Intraoperatively On Postoperative Thoracic Drainage

Objective: Thoracotomy trauma is large in surgical operative.Peroperative management is a key link of successful thoracic surgery.Postoperative drainage is an unignored factor which affects postoperativerecoveries. Indwelling drainage tube could discharge gas and effusion residuedin the chest, operative side lung recruitmentedas soon as possible. It willincrease the pleural fluid accumulation which thereby holds back therecoveries of patients even bring more agony unexpected. Indwelling thedrainage tube may lengthen the recovery process and increase the risk ofinfection. So it’s a problem ever thoracic Surgeon need to face and solve thatcontrol the Drainage volume In an appropriate range in addition to completelyhemostasized.In recent years, varieties of researches on thrombin are emergingendlessly. Thrombin is a trypsin-like serine protease protein which is encodedby the F2gene in human body. Prothrombin (coagulation factor Ⅱ) could beconversed into thrombin by proteolytic excision. It could converse the solublefibrinogen into Insoluble fibrin as well as catalyze reactions associated withblood clotting. Cascade reaction prevented the loss of blood ultimately. Therange of applications of thrombin is expanded. Topical hemostatic, Surgicalwound hemostasis，ENT wounds, gynecologic wounds, and Gastrointestinalhemostasis and so on. It is also applicated in clinical as some Topicalhemostatic agents’ feedstock. As the study of mechanisms of action goingdeep, the application in cerebral hemorrhage, cardiovascular disease andendocrine disease is mastered Appropriatly on and on. Our experiment isaimed to observe the effect of controlling postoperative drainage ofintraoperatively sprayed lyophilized Thrombin.Methods: we choose the patents that were hospitalized and thoracotomily operated during January2013-March2014as our objects ofstudy. And they should meet the following conditions:1.The tumor’s locationis in the middle or lower esophagus or cardia, there are no Pleural adhesions orPleural effusion under CT;2. there is no abnormity in cardiopulmonaryfunction, electrocardiogram and liver and kidney function.3. No infection inthe pleural cavity or lung during the perioperative stage. No high fever;4. Thesurgery was managed by the same group of doctors.5. There were no extratraumas such as rib fractures.6. Indwelling thoracic drainage tube opened.7.The consent was obtained from the patients themselves and their families. Weseparated our studied objects into two parts randomly: the experimental groupand control group. We put the lyophilized thrombin solution (4000IU, in5mlnormal saline) on the wound in the chest of the experimental group patients,but only normal saline for the control group. Before the measures, we shouldclean up the exudates and blood on the inside surface of the wound. Observethe postoperative vital signs and systemic or local adverse reactions closely.Record the drainage volume, the date the thoracic drainage tube unplugged.Collect3-4ml pleural cavity fluid drainage every24hours for three days forred blood cell counting and another2-5ml for keeping centrifuged supernatantin the-80℃refrigerator for the measuring and evaluating of the concentrationof PAI-1and IL-8by ELISA. We also statistically analyzed the collecteddatum.Results:1Patients’ postoperative vital signs were stable, no local or systemic adversereactions such as rash, anaphylactic shock and so on.2We compared the patients’ general situation between the experimental groupand the control group founding no significant differences (P>0.05), forexample the body surface area (1.65±0.115m2,1.64±0.126m2), age(56.90±9.61y,56.07±12.98y), weight (61.07±7.14kg,61.41±7.23kg), height(168.20±6.73cm,166.63±7.36cm), gender ratio (10/9) etc. Distribution oftumor location is, experimental group: Esophageal7, lower esophageal13,cardia10, control group: Esophageal6, lower esophageal10, cardia11. 3compared the first there days drainage between experimental group and thecontrol group: the first day:(443.00±114.98ml，(513.27±150.63ml)；thesecond day:(241.67±85.484ml)，(343.27±67.867ml)；the third day (133.00±69.44ml)，(242.69±75.81ml). The difference was statistically significant(P<0.05).4The experimental group and the control group’s median number of dayswearing the drainage tube are:4days,5days, the interquartile range are：1day,3days. It’s statistical significantly different between the experimental groupand the control group(P<0.05).5The result of comparing red blood cell count between the experimentalgroup and the control group is: the first day:(0.194±0.05678)*109/L,(0.316±0.11256)*109/L； the second day:(0.167±0.33164)*109/L，(0.204±0.20356)*109/L； the third day:(0.053±0.02496)*109/L，(0.114±0.03717)*109/L. The difference was statistically significant (P<0.05).6. The concentration of PAI-1in the first3days’ pleural cavity fluid drainageis: the first day:1.951±0.427ng/ml,1.629±0.297ng/ml；the second day:2.172±0.466ng/ml,1.687±0.247ng/ml；the third day:2.027±0.425ng/ml1.716±0.270ng/ml. The difference between the experimental group and thecontrol group was statistically significant (P<0.05).7. The concentration of IL-8in the first3days’ pleural cavity fluid drainage is:the first day:155.42±35.186pg/ml,148.65±32.776pg/ml; the second day:175.08±31.824pg/ml,159.66±45.572pg/ml; the third day:152.93±23.167pg/ml,143.42±33.161pg/ml. The difference between the different dayswas statistically significant (P<0.05). The difference between the experimentalgroup and the control group was not statistically significant (P>0.05).Conclusions:1Thrombin can reduce the thoracotomic postoperative drainage and shortenthe wear time of thoracic drainage tube, ease the patient’s aches and pains, andcontribute to patients’ recovery.2Thrombin hold back the inside wounds’ oozing or bleeding by Promotingblood clotting directly, and by promoting the growth and proliferation of vascular endothelial cells and vascular smooth muscle cells.3Thrombin may stimulate pleural mesothelial cells to produce plasminogenactivator inhibitor (PAI-1), breaking the pleural fibrinolytic/procoagulantbalance and promote pleural adhesions; thereby reducing pleural effusion.4Thrombin possible accelerate wound healing by stimulating inflammation toinhibit postoperative drainage, and it needs more reserch.