生物蛋白胶胸骨内注射治疗老年骨质疏松冠状动脉搭桥后的胸骨出血  

Injection of fibrin glue directly into the sternum for sternal bleeding in old patients with osteoporosis during coronary artery bypass

作　　者：张玉海[1] 谷天祥[1] 张光伟[1] 王春[1] 刘玉[1] 于洋[1] 

机构地区：[1]中国医科大学附属第一医院心脏外科,辽宁省沈阳市110001

出　　处：《中国组织工程研究与临床康复》2011年第25期4735-4738,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：辽宁省教育厅高校科研基金资助项目(2004C050)~~

摘　　要：背景:目前临床多应用创面涂抹方式发挥医用生物蛋白胶的止血作用,但骨腔内注射应用报道少见。目的:观察胸骨内注射生物蛋白胶对老年严重骨质疏松冠状动脉搭桥患者正中开胸出血的效果。方法:将48例体外循环下行正中开胸冠状动脉搭桥手术的75岁以上的严重骨质疏松患者随机数字表法分成实验组和对照组。实验组胸骨腔内注射生物蛋白胶,对照组常规涂抹医用骨蜡,记录两组术后12h引流量及总引流量、拔引流管时间及术后胸骨切口愈合情况。结果与结论:实验组术后12h引流量和总引流量、拔引流管时间及平均住院时间均较对照组明显减少(P<0.05),两组术后持续发热时间、术后胸骨感染裂开情况无明显差异。对照组术后胸骨切口感染裂开1例,实验组未发现不良反应。说明胸骨内注射生物蛋白胶能减少老年严重骨质疏松患者体外循环冠状动脉搭桥手术胸骨出血,减少出血相关并发症,不影响胸骨愈合。BACKGROUND：Currently,fibrin glue play a hemostasis role through wound smearing;however,studies about injection of fibrin glue into the bone cavity are rare.OBJECTIVE：To observe the effect of injecting fibrin glue directly into the sternum for hemostasis in elder patients with osteoporosis during coronary artery bypass.METHODS：Forty-eight elder patients with severe osteoporosis,aged over 75 years,undergoing the coronary artery bypass were randomly divided into 2 groups using random digits table：experimental group and control group.Fibrin glue injected directly into the sternum in the experimental group;bone wax was used to stop bleeding in the control group.The drainage volume within the first 12 hours,total postoperative volume,the time of removing the drainage tube,wound healing condition were recorded and observed.RESULTS AND CONCLUSION：As compared with the control group,the drainage volume within the first 12 hours and total volume,the time of removing the drainage tube and the time of discharge were obviously decreased in the experimental group（P 0.05）,but there was no significant difference in the time of continuous fever and the number of patients with postoperative sternal rupture between the two groups.In the control group,there was 1 case of wound infection and dehiscence.No adverse effects were found in the experimental group.It is indicated that direct injection of fibrin glue into the sternum can decrease the occurrence of hemorrhage and complications,and have no effect on sternum healing in elder patients with severe osteoporosis during coronary artery bypass.

关 键 词：生物蛋白胶 骨质疏松 胸骨出血 体外循环 冠状动脉搭桥 

分 类 号：R318[医药卫生—生物医学工程]