中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2013年
7期
22-23
,共2页
孙俊峰%路培法%孙作永%郑晓勇%程学飞
孫俊峰%路培法%孫作永%鄭曉勇%程學飛
손준봉%로배법%손작영%정효용%정학비
外科肌瓣%感染%胸骨%封闭式负压引流
外科肌瓣%感染%胸骨%封閉式負壓引流
외과기판%감염%흉골%봉폐식부압인류
Surgical flap%Infection%Sternum%VSD
目的 探讨大血管及心脏手术后胸骨感染的有效治疗方式.方法 回顾性分析2007年1月至2012年7月20例心脏大血管手术后发生胸骨感染患者的临床资料,男12例,女8例;年龄23 ～ 68岁,平均(45±11)岁.20例患者均采用封闭式负压引流(VSD)积极清创,包括清除坏死皮缘和增生组织、彻底止血、搔刮胸骨、咬除感染胸骨、清除胸骨后的感染脓腔、用1％碘伏纱布浸泡,抗生素液反复冲洗,然后封闭式负压引流平均治疗10d.待创面肉芽组织新鲜、感染控制后,采用游离带蒂胸大肌肌瓣,双侧胸大肌对接,填充填塞死腔.结果 20例患者中切口Ⅰ期愈合18例,Ⅱ期愈合2例,经抗炎换药后愈合,随访6个月～7年,全部患者切口无感染,生活能力和工作能力等方面明显优于其他手术方式.结论 对心脏大血管手术后发生胸骨感染患者应积极行外科手术清创,放置封闭式负压引流,采用游离带蒂胸大肌肌瓣,双侧胸大肌对接,填充填塞死腔,可尽快控制感染,促进切口愈合.
目的 探討大血管及心髒手術後胸骨感染的有效治療方式.方法 迴顧性分析2007年1月至2012年7月20例心髒大血管手術後髮生胸骨感染患者的臨床資料,男12例,女8例;年齡23 ～ 68歲,平均(45±11)歲.20例患者均採用封閉式負壓引流(VSD)積極清創,包括清除壞死皮緣和增生組織、徹底止血、搔颳胸骨、咬除感染胸骨、清除胸骨後的感染膿腔、用1％碘伏紗佈浸泡,抗生素液反複遲洗,然後封閉式負壓引流平均治療10d.待創麵肉芽組織新鮮、感染控製後,採用遊離帶蒂胸大肌肌瓣,雙側胸大肌對接,填充填塞死腔.結果 20例患者中切口Ⅰ期愈閤18例,Ⅱ期愈閤2例,經抗炎換藥後愈閤,隨訪6箇月～7年,全部患者切口無感染,生活能力和工作能力等方麵明顯優于其他手術方式.結論 對心髒大血管手術後髮生胸骨感染患者應積極行外科手術清創,放置封閉式負壓引流,採用遊離帶蒂胸大肌肌瓣,雙側胸大肌對接,填充填塞死腔,可儘快控製感染,促進切口愈閤.
목적 탐토대혈관급심장수술후흉골감염적유효치료방식.방법 회고성분석2007년1월지2012년7월20례심장대혈관수술후발생흉골감염환자적림상자료,남12례,녀8례;년령23 ～ 68세,평균(45±11)세.20례환자균채용봉폐식부압인류(VSD)적겁청창,포괄청제배사피연화증생조직、철저지혈、소괄흉골、교제감염흉골、청제흉골후적감염농강、용1％전복사포침포,항생소액반복충세,연후봉폐식부압인류평균치료10d.대창면육아조직신선、감염공제후,채용유리대체흉대기기판,쌍측흉대기대접,전충전새사강.결과 20례환자중절구Ⅰ기유합18례,Ⅱ기유합2례,경항염환약후유합,수방6개월～7년,전부환자절구무감염,생활능력화공작능력등방면명현우우기타수술방식.결론 대심장대혈관수술후발생흉골감염환자응적겁행외과수술청창,방치봉폐식부압인류,채용유리대체흉대기기판,쌍측흉대기대접,전충전새사강,가진쾌공제감염,촉진절구유합.
Objective To investigate the effective treatment method of large blood vessels and sternal infection after cardiac surgery.Methods Retrospectively analysed 20 cases of cardiovascular operation occurred after sternal infection in patients with the clinical data from January 2007 to July 2012,male in 12 cases,female in 8 cases; 23-68 years old,average age was (44.8 ± 10.9)years old.Twenty cases were treated with closed negative pressure drainage (VSD) aggressive debridement,including removal of the necrotic skin and hyperplastic tissue,hemostasis,scratching,biting the sternum sternal infection,in addition to remove after sternal infection,abscess cavity with 1％ iodophor gauze soaked,with antibiotic solution repeatedly washed,then VSD average treatment time was 10 d.When wound granulation tissue was fresh,infection controlles,using free pedicled pectoralis major muscle flap,bilateral pectoralis major muscle docking,filled with dead space.Results Of the 20 cases,stage Ⅰ wound healing in 18 cases,stage Ⅱin 2 cases,the wound healed with antibiotic treatment.Follow-up for 6 months to 7 years,all cases had no wound infection,and their life skills and work ability,was significantly better than the other operation method.Conclusions The major vessels of the heart operation occurred after sternal infection in patients with surgical operation should be performed debridement,placing the closed negative pressure drainage (VSD),and use free and pedicled pectoralis major muscle flap,docking the bilateral pectoralis major muscle,filled with dead space,and can be as soon as possible to control infection,promote wound healing.
