心血管术后胸骨感染的外科治疗经验  

Experience of surgical treatment of postoperative cardiovascular sternal infection

作　　者：孙俊峰[1] 路培法[1] 孙作永[1] 郑晓勇[1] 程学飞[1] 

机构地区：[1]山东省滨州市人民医院心胸外科,山东省滨州市256610

出　　处：《中国实用医刊》2013年第7期22-23,共2页Chinese Journal of Practical Medicine

摘　　要：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。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 Ⅱ in 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 mus- cle, filled with dead space, and can be as soon as possible to control infection, promote wound healing.

关 键 词：外科肌瓣 感染 胸骨 封闭式负压引流 

分 类 号：R249[医药卫生—中医临床基础] R269[医药卫生—中医学]