心脏外科术后累及胸骨的深部切口感染的外科治疗分析  

Surgical treatment analysis of deep incision infection involving sternum after cardiac surgery

作　　者：张辉[1] Zhang Hui(Department of Cardiovascular Surgery,Henan Chest Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省胸科医院心血管外科,河南郑州450000

出　　处：《辽宁医学杂志》2018年第5期32-34,共3页Medical Journal of Liaoning

摘　　要：目的探究外科治疗心脏外科术后累及胸骨的深部切口感染的效果分析。方法回顾分析2017年6月-2018年5月经胸骨正中切口行心脏手术成人患者288例,其中术后发生深部胸骨切口感染的患者68例;分析不同临床分型的心脏外科术后深部胸骨切口感染临床特点,在患者确诊后将原手术切口开放,采用纱条换药引流,同时静脉注射广谱抗生素治疗,待原手术切口创面清洁或肉芽组织新鲜后在给予手术清创术。首先选择保留胸骨的清创术,而对于胸骨坏死严重或清创术失败后需再行二次清创手术的患者,行胸大肌肌瓣或腹直肌肌瓣转移术。结果痊愈出院48例,其中9例患者需要进行二次以上清创手术。死亡患者9例,此外有11例患者要转到专科医院继续治疗。其中患者出现并发症的包括全身感染9例,严重瓣周漏2例,清创手术中发生心脏破裂出血3例,清创术后CABG旁路血管出血1例。平均住院时间(38±31) d。结论胸骨的深部切口感染为心脏外科术后较严重的并发症,在临床治疗上应给予高度重视,及早发现病情,尽早引流并给予清创手术,避免感染的扩散,从而导致其他组织和器官的严重并发症。Objective To investigate the effect of surgical treatment of deep incision infection involving sternum after cardiac surgery.Methods A retrospective analysis of 288adult patients undergoing cardiac surgery through the sternal median incision from June 2017to May 1818,including 68patients with deep sternal incision infection after operation;analysis of deep sternal incision after cardiac surgery with different clinical classifications Infected clinical features,the original surgical incision is opened after the patient is diagnosed,the gauze dressing is used for drainage,and the broad-spectrum antibiotic is treated by intravenous injection.The surgical debridement is performed after the original surgical incision wound is cleaned or the granulation tissue is fresh.First,the debridement of the sternum was selected,and the pectoralis major myo- cutaneous or rectus abdominis muscle flap was transferred to patients with severe sternal necrosis or debridement after debridement.Results Of the 48 patients who were discharged from hospital,9 patients required more than two debridement operations.Nine patients died,and 11 patients were transferred to specialist hospitals for further treatment.Among them,9 patients had systemic infection,2patients had severe paravalvular leakage,3 patients had cardiac rupture during debridement surgery,and 1 patient had CABG bypass vascular hemorrhage after debridement.The average hospital stay was (38±31)d.Conclusion The deep incision infection of the sternum is a serious complication after cardiac surgery.It should be given high attention in clinical treatment,early detection of the disease,early drainage and debridement surgery to avoid the spread of infection,leading to other tissues and organs.Serious complications.

关 键 词：心脏外科 深部切口感染 外科治疗 胸骨 

分 类 号：R654.2[医药卫生—外科学]