[1]王常田,黄海嵘,张雷,等.心血管手术后胸骨伤口并发症的外科治疗[J].医学研究与战创伤救治(原医学研究生学报),2017,19(03):298-301.[doi:10.3969/j.issn.1672-271X.2017.03.019]
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心血管手术后胸骨伤口并发症的外科治疗(
)
)《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]
- 卷:
- 第19卷
- 期数:
- 2017年03期
- 页码:
- 298-301
- 栏目:
- 出版日期:
- 2017-05-20
文章信息/Info
- Title:
- -
- Keywords:
- -
- 分类号:
- R654.2
- 文献标志码:
- B
- 摘要:
- 目的 心血管手术后胸骨伤口并发症严重影响患者的预后，处理较棘手。文章分析其发病率、危险因素，总结外科治疗经验和结果 。方法 分析南京军区南京总医院2006年1月至2016年1月心血管手术后出现胸骨伤口并发症21例患者的临床资料，其中男14例，女7例。年龄38～78岁，平均（66.3±10.1）岁。单纯冠状动脉旁路移植术（CABG）13例，CABG合并瓣膜病1例，单纯瓣膜手术5例，大血管手术2例。胸骨伤口裂开者立即重新钢丝固定。深部胸骨伤口感染确诊后即开放伤口，纱条换药引流，同时经静脉经予广谱抗生素，待伤口创面干净、肉芽新鲜结合患者全身情况再行清创术或肌瓣转移修复术。结果 胸骨伤口裂开5例，深部胸骨伤口感染16例，伤口愈合时间分别为（15.4±11.0）d和（73.8±50.5）d，总住院时间分别为(29.0±9.4)d和(86.3±59.4)d，伤口愈合时间和总住院时间在深部胸骨伤口感染组明显延长（P<0.05）。深部胸骨伤口感染行保守治疗10例，积极治疗6例，伤口愈合时间分别为(94.1±60.3)d和(29.2±8.5)d，总住院时间分别为(106.3±68.1)d和(43.1±11.4)d，采取积极清创后伤口愈合时间和总住院时间均有明显下降（P<0.05）。 痊愈19例（90.5%），死亡2例（9.5%）。随访感染无复发。结论 心血管术后胸骨伤口并发症是严重的手术并发症，应根据伤情种类、患者全身情况综合考虑治疗方案，重点预防和早期发现加上充分引流和彻底清创对减少该并发症提高治愈率有重要意义。
- Abstract:
- -
参考文献/References:
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[12]王常田，李德闽，申翼，等. 2种欧洲心脏手术风险评估系统评分对冠状动脉旁路移植术风险的预测价值[J]. 医学研究生学报, 2010,23(7): 721-724.
[13]Shaikhrezai K, Robertson FL, Anderson SE, et al. Does the number of wires used to close a sternotomy have an impact on deep sternal wound infection [J].Interact Cardiovasc Thorac Surg, 2012,15(2): 219-222.
[14]王常田，李德闽，景华，等.老年患者冠状动脉旁路移植术的围术期处理[J]. 医学研究生学报, 2008, 21(8): 820-822.
[15]Lindblom RP, Lytsy B, Sandstrm C, et al. Outcomes following the implementation of a quality control campaign to decrease sternal wound infections after coronary artery by-pass grafting[J]. BMC Cardiovasc Disord, 2015,15:154-163.
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