不同心脏手术术后胸部感染危险因素分析  

Risk factors for sternal wound infection after various cardiac operations

作　　者：潘俊[1] 宣煜龙[1] 王东进[1] 

机构地区：[1]南京大学医学院附属鼓楼医院心胸外科,南京210008

出　　处：《中国胸心血管外科临床杂志》2017年第4期281-284,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探索不同心脏外科手术方式患者术后胸部伤口感染的危险因素。方法本次研究为单中心回顾性分析,自2010~2014年共纳入2 924例连续患者,28%为女性,中位年龄68岁(四分位数间距60~76岁),手术方式包括单纯冠状动脉旁路移植术(CABG)、单纯瓣膜成形或置换术和瓣膜手术+CABG。结果全组2 924例患者中110例胸部伤口感染,其中1 671例CABG患者中有67例(4.0%),719例瓣膜术后患者中有17例(2.4%),534例瓣膜手术+CABG患者中有26例(4.9%)。对CABG患者,取双侧胸廓内动脉、手术时间>300 min、糖尿病、肥胖、慢性阻塞性肺疾病、女性为术后胸骨伤口感染的独立危险因素。对瓣膜手术患者,仅有二次开胸止血为独立危险因素。对瓣膜手术+CABG患者,二次开胸止血及手术时间>300 min为独立危险因素。结论心脏手术术后出现胸部伤口感染的危险因素与手术方式有关,对瓣膜手术或瓣膜+CABG患者,手术方式相关的危险因素(出血、手术时间)为伤口感染的独立危险因素。对CABG患者,手术相关的危险因素及选择双侧胸廓内动脉作血管桥、患者基线状态(糖尿病、肥胖、慢性阻塞性肺疾病、女性)为术后伤口感染的独立危险因素。根据手术方式的不同进行早期干预可能降低患者术后胸部伤口感染的发生率。Objective To evaluate the risk factors for sternal wound infections after various cardiac operations.Methods We retrospectively analyzed the clinical data of 2 924 consecutive patients（28% female） in our hospital from2010 to 2014 year. Their median age was 69 years（interquartile range of 60 to 76 years）. Procedures included isolated coronary artery bypass grafting（CABG）, isolated valve repair or replacement, and valve procedures plus CABG. Results Sternal wound infection was detected in 110（3.8%） patients among the 2 924 patients： 67 of 1 671 patients（4.0%） after CABG, 17 of 719（2.4%） after valve operations, and 26 of 534（4.9%） after valve＋CABG operation. In the CABG patients,bilateral internal thoracic artery harvest procedure, operation time300 minutes, diabetes, obesity, chronic obstructive pulmonary disease, and female were independent risk factors for sternal wound infection. In the valve operation patients,only revision for bleeding as an independent predictor for sternal infection. For combined valve plus CABG patients,revision for bleeding and operation time300 minutes were independent risk factors for sternal infection. Conclusion Risk factors for sternal wound infections after cardiac operations vary with the type of surgical procedure. In patients undergoing valve operations or combined operations, procedure-related risk factors（revision for bleeding, operation time） independently predict infection. In patients undergoing CABG, not only procedure-related risk factors but also bilateral internal thoracic artery harvest and patient characteristics（diabetes, chronic obstructive pulmonary disease,obesity, female） are predictors of sternal wound infection. Preventive interventions may be justified according to the type of operation.

关 键 词：胸骨感染 心脏手术 危险因素 

分 类 号：R654.2[医药卫生—外科学]