CAJ | 학술논문

目的分析心脏外科胸骨正中切口术后发生累及胸骨的深部切口感染的病种分布、发病率、危险因素、治疗经验及预后.方法回顾性分析2010年1月至2013年9月29 574例经胸骨正中切口行心脏手术的年龄大于17岁的成人患者,共有139例(0.47％)患者发生累及胸骨的深部切口感染.其中男性患者111例(79.9％),女性患者28例(20.1％);平均年龄(61±11)岁,平均体重(74±14)kg.单纯冠状动脉旁路移植术(CABG)91例,占同期同类手术的0.88％(91/10 341,下同),CABG合并瓣膜或室壁瘤切除等其他心脏手术(联合CABG)15例(0.70％,15/2 143),单纯瓣膜置换或成形术24例(0.21％,24/11 429),大血管手术3例(0.15％,3/2 002),先天性心脏病及其他手术6例(0.19％,6/3 158).患者确诊后即开放原手术切口,纱条换药引流,同时经静脉给予广谱抗生素治疗,待伤口创面清洁、肉芽新鲜后入手术室行清创术,手术方式首选保留胸骨的清创手术,对于探查发现胸骨坏死严重或者清创手术失败后需要行二次清创手术的患者,行胸大肌肌瓣或腹直肌肌瓣转移术.结果痊愈出院112例(80.6％),其中有15例(10.8％)患者需要在院内接受两次以上清创手术.住院死亡13例(9.3％).另有14例(10.1％)需要转往专科医院继续治疗.其他并发症包括全身感染13例、严重瓣周漏3例、清创手术中发生心脏破裂出血4例、清创术后CABG旁路血管出血1例.平均住院时间(39±30)d.结论心脏外科术后累及胸骨的深部切口感染是一种严重的手术并发症.在治疗上应给予足够的重视,尽早发现并确诊、彻底引流,尽早行清创手术,避免感染范围扩大所导致的其他严重并发症是治疗成功的关键.
목적 분석심장외과흉골정중절구술후발생루급흉골적심부절구감염적병충분포、발병솔、위험인소、치료경험급예후.방법 회고성분석2010년1월지2013년9월29 574례경흉골정중절구행심장수술적년령대우17세적성인환자,공유139례(0.47％)환자발생루급흉골적심부절구감염.기중남성환자111례(79.9％),녀성환자28례(20.1％);평균년령(61±11)세,평균체중(74±14)kg.단순관상동맥방로이식술(CABG)91례,점동기동류수술적0.88％(91/10 341,하동),CABG합병판막혹실벽류절제등기타심장수술(연합CABG)15례(0.70％,15/2 143),단순판막치환혹성형술24례(0.21％,24/11 429),대혈관수술3례(0.15％,3/2 002),선천성심장병급기타수술6례(0.19％,6/3 158).환자학진후즉개방원수술절구,사조환약인류,동시경정맥급여엄보항생소치료,대상구창면청길、육아신선후입수술실행청창술,수술방식수선보류흉골적청창수술,대우탐사발현흉골배사엄중혹자청창수술실패후수요행이차청창수술적환자,행흉대기기판혹복직기기판전이술.결과 전유출원112례(80.6％),기중유15례(10.8％)환자수요재원내접수량차이상청창수술.주원사망13례(9.3％).령유14례(10.1％)수요전왕전과의원계속치료.기타병발증포괄전신감염13례、엄중판주루3례、청창수술중발생심장파렬출혈4례、청창술후CABG방로혈관출혈1례.평균주원시간(39±30)d.결론 심장외과술후루급흉골적심부절구감염시일충엄중적수술병발증.재치료상응급여족구적중시,진조발현병학진、철저인류,진조행청창수술,피면감염범위확대소도치적기타엄중병발증시치료성공적관건.
Objective To retrospectively evaluate the results of deep sternal wound infection (DSWI) after cardiac surgery.Methods Between January 2010 and September 2013,139 patients suffering from DSWI after median sternotomy.The incidence of DSWI was 0.47％ (139/29 574).There were 111 (79.9％) male and 28 (20.1％) female patients.The mean age was (61 ± 11) years,the mean body weight was (74 ± 14) kg.The incidence of postoperative DSWI was 0.88 ％ (91 / 10 341) after isolated coronary artery bypass grafting (CABG),0.70％ (15/2 143) after valve surgery or other cardiac surgery plus CABG,0.21％ (24/11 429) after valve surgery,0.15％ (3/2 002) after thoracic aortic surgery,and 0.19％ (6/3 158) after congenital heart disease.The sternotomy was re-opened and extensive debridement of the wound was performed in all patients.When the wound was clean and there was a bed of fresh granulation tissue,the sternum was rewired.The surgical procedure performed included debridement,drainage,sternal wire reclosure and pectoralis major muscular transpositions depended on the clinical condition of the patient.Results The in-hospital mortality was 9.3％.Failure of secondary sternal refixation appeared in 15 (10.8％) patients,the reoperation procedure of these 15 patients was pectoralis major muscular transpositions.Other complications included sepsis in 13 patients,perivalvular leakage in 3 patients,and cardiac rupture during the surgical procedure in 3 patients.The mean hospitalization was (39 ± 30) days.Conclusion Deep sternal wound infection is a life-threatening complication after cardiac surgery associated with high morbidity and mortality.