封闭负压引流技术在心脏手术后切口感染治疗中的应用  

Vacuum Sealing Drainage for Patients with Wound Infection after Cardiac Surgery

作　　者：王显悦[1] 王晓武[1] 毕生辉[1] 梅鲁刚[1] 梁爱琼[1] 徐宇[1] 张卫达[1] 

机构地区：[1]广州军区总医院心脏外科中心,广州510010

出　　处：《中国胸心血管外科临床杂志》2012年第5期529-533,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：广州市科技计划重点项目(2011J4100021)~~

摘　　要：目的探讨封闭负压引流技术对心脏手术后胸骨正中切口感染的治疗效果。方法回顾性分析2008年1月至2012年1月广州军区总医院70例心脏病(包括心瓣膜病、冠心病、先天性心脏病等)行心脏手术后发生胸骨正中切口感染患者的临床资料,术后按对感染切口的处理方法不同,将70例切口感染(切口长度>5 cm)患者用随机数字表法分为两组,封闭负压引流组:35例,使用封闭负压引流(vacuum sealing drainage)技术治疗胸骨正中切口感染;对照组:35例,采用常规治疗方法处理感染切口。比较两组的治疗效果、切口感染持续时间、抗生素使用时间和治疗费用等。结果两组无死亡。封闭负压引流组大多数患者经封闭负压引流技术治疗后,感染切口渗出物明显减少,肉芽填充良好;治愈率明显高于对照组(94.3%vs.60.0%,P<0.05)。封闭负压引流组患者切口感染持续时间[(12.9±3.4)d vs.(14.8±4.1)d;t=-2.094,P=0.040)],抗生素使用时间[(7.0±1.5)d vs.(8.3±1.9)d;t=-2.920,P=0.005)]均短于对照组,治疗费用与对照组比较差异无统计学意义(P>0.05)。封闭负压引流组术后随访15例(42.9%),随访时间3个月,伤口愈合良好;失访20例。结论采用封闭负压引流技术治疗胸骨正中切口感染,效果好、治疗时间短、治疗费用与常规治疗方法接近。Objective To evaluate outcomes of vacuum sealing drainage（VSD）for the treatment of wound infection after cardiac surgery.Methods We retrospectively analyzed clinical data of 70 patients（with valvular heart disease,congenital heart disease or coronary heart disease）who underwent cardiac surgery via mid-sternotomy and had postoperative wound infection from Jan.2008 to Jan.2012 in General Military Hospital of Guangzhou Command.According to different treatment strategy for wound infection,all the patients with wound infection（incision longer than 5 cm） were randomly divided into VSD group（n=35） and control group（n=35） by random number table,while VSD treatment was used for patients in VSD group and routine treatment was used for patients in control group.Treatment outcome,duration of wound infection,duration of antibiotic treatment and treatment cost were compared between the two groups.Results There was no in-hospital death in both groups.Wound exudate significantly decreased and fresh granulation tissue grew well in the wound in most VSD group patients after VSD treatment.The cure rate of VSD group was significantly higher than that of control group（94.3% vs.60.0%,P0.05）.Duration of wound infection（12.9±3.4 d vs.14.8±4.1 d;t=-2.094,P=0.040）and duration of antibiotic treatment（7.0±1.5 d vs.8.3±1.9 d;t=-2.920,P=0.005） of VSD group were significantly shorter than those of control group.There was no statistical difference in treatment cost between the two groups.Fifteen patients in VSD group were followed up（42.9%） for 3 months with good wound healing,and 20 patients in VSD group were lost in follow-up.Conclusion VSD is effective for the treatment of wound infection after cardiac surgery with shortened treatment duration and similar treatment cost compared with routine treatment.

关 键 词：封闭负压引流 心脏手术 切口感染 

分 类 号：R654.2[医药卫生—外科学]