中国伤残医学
中國傷殘醫學
중국상잔의학
CHINESE JOURNAL OF TRAUMA AND DISABILITY MEDICINE
2014年
19期
3-4
,共2页
纵膈感染%心脏外科%手术
縱膈感染%心髒外科%手術
종격감염%심장외과%수술
Mediastinitis%Cardiac surgery%Operation
目的：总结经胸骨正中切口行心脏手术后发生纵隔感染的诊治经验。方法：对2005年9月～2012年10月，我科47例胸骨正中切口心脏术后纵隔感染病人的临床表现，诊断方法，鉴别诊断，治疗手段，及预后进行回顾分析，10例行胸骨固定，纵膈冲洗，其中2例行胸大肌肌瓣填充修补，37例局部切开引流换药，47例患者发热6例，无发热41例，患者中毒症状6例，无中毒症状者41例，47例患者均有切口渗出和胸骨不稳定，切口分泌物培养18例阳性，其中MRSA 2例，根据药物敏感试验结果调整抗生素。结果：死亡6例，死亡率12％，见于中毒症状者和MRSA感染者。余患者均存活。随访1～5年，无远期死亡，感染复发3例。结论：胸骨正中切口行心脏手术后，纵膈感染是一种危及生命的严重并发症，早期清创、开放引流冲洗是有效的治疗方法。严重感染者预后极差。
目的：總結經胸骨正中切口行心髒手術後髮生縱隔感染的診治經驗。方法：對2005年9月～2012年10月，我科47例胸骨正中切口心髒術後縱隔感染病人的臨床錶現，診斷方法，鑒彆診斷，治療手段，及預後進行迴顧分析，10例行胸骨固定，縱膈遲洗，其中2例行胸大肌肌瓣填充脩補，37例跼部切開引流換藥，47例患者髮熱6例，無髮熱41例，患者中毒癥狀6例，無中毒癥狀者41例，47例患者均有切口滲齣和胸骨不穩定，切口分泌物培養18例暘性，其中MRSA 2例，根據藥物敏感試驗結果調整抗生素。結果：死亡6例，死亡率12％，見于中毒癥狀者和MRSA感染者。餘患者均存活。隨訪1～5年，無遠期死亡，感染複髮3例。結論：胸骨正中切口行心髒手術後，縱膈感染是一種危及生命的嚴重併髮癥，早期清創、開放引流遲洗是有效的治療方法。嚴重感染者預後極差。
목적：총결경흉골정중절구행심장수술후발생종격감염적진치경험。방법：대2005년9월～2012년10월，아과47례흉골정중절구심장술후종격감염병인적림상표현，진단방법，감별진단，치료수단，급예후진행회고분석，10례행흉골고정，종격충세，기중2례행흉대기기판전충수보，37례국부절개인류환약，47례환자발열6례，무발열41례，환자중독증상6례，무중독증상자41례，47례환자균유절구삼출화흉골불은정，절구분비물배양18례양성，기중MRSA 2례，근거약물민감시험결과조정항생소。결과：사망6례，사망솔12％，견우중독증상자화MRSA감염자。여환자균존활。수방1～5년，무원기사망，감염복발3례。결론：흉골정중절구행심장수술후，종격감염시일충위급생명적엄중병발증，조기청창、개방인류충세시유효적치료방법。엄중감염자예후겁차。
Objective:To summarize the experience of diagnosis and treatment of mediastinitis relevant to cardiac surgery procedures via median sternal incision .Method s:From September 2005 to October 2012, mediastinitis developed in 47 ( 2.8%) of 1645 consecu-tive cardiac surgery procedures via median sternal incision .We reviewed the variation of clinical characteristics、diagnostic approach 、dif-ferential diagnosis、treatment approch and the prognosis in these patients .10 patients underwent extensive sternal and soft tissue debride-ment and dosed mediastinal irrigation with antiseptic solution and drainage through tubes .Two of them were given plastics procedures using rectus abdominus flaps or pectoralis major muscle flaps ,Only local drainage and irrigation with antiseptic solution were given in 37 be-cause of the mild infection .6 patients of 47 patients had a fever , the others had no fever , All of 47 patients had incision exudation and sternum unstability ,Samples of sternal drainage and arterial blood were sent for culture to establish a diagnosis and to tailor antimicrobial therapy .18 patients had positive culture , 2 patients of them had MRSA infection , Antibiotics were selected based on the culture and sen-sitivity data .Results:There were 6 hospital death (12.7 %) in toxic symptom and MRSA infection , there was no death in other patiens during the follow-up of 1-5 years,3 patients had infection recurrence .Conclusion :Mediastinitis associated with cardiac surgery via sternal incision is a life -threatening condition with a high mortality rate , Earlier recognition and prompt surgical intervention are impor-tant.Immediately drainage , debridement and mediastinal irrigation could improve the outcome of this dreadly complication .The prognosis of serious infection patients were worse.
