钛镍合金钢板用于老年非体外循环冠状动脉旁路移植术患者固定胸骨的效果研究  

Titanium and nickel alloy fixation of sternum in senile off-pump coronary artery bypass grafting operation

作　　者：杜志明[1] 余冬敏[1] 唐志贤[1] 赖政洪[1] 刘子由[1] Du Zhiming;Yu Dongmin;Tang Zhixian;Lai Zhenghong;Liu Ziyou(Department of Cardiothoracic Surgery,First Affiliated Hospital of Gannan Medical University,Jiangxi Province,Ganzhou 341000,China)

机构地区：[1]赣南医学院第一附属医院心胸外科,江西省赣州市341000

出　　处：《中国医药》2020年第2期194-197,共4页China Medicine

基　　金：国家自然科学基金(81860337)。

摘　　要：目的探讨使用钛镍合金钢板在老年非体外冠状动脉旁路移植术患者中固定胸骨并预防胸骨哆开的效果。方法选取2013年5月至2019年5月赣南医学院第一附属医院心胸外科实施非体外循环冠状动脉旁路移植术的老年患者72例。按照术中使用不同胸骨固定材料分为钢丝固定组(37例)和钛镍合金固定组(35例)。记录2组患者的手术时间、术后呼吸机辅助时间、术后住院时间、术后不同时间段的疼痛视觉模拟量表(VAS)评分,术中主动脉内球囊反搏使用率,以及术后胸骨哆开、肺部感染、切口感染等并发症发生率。结果钢丝固定组术后有4例患者出现胸骨哚开,发生率为10.8%(4/37),合金固定组中无胸骨哆开发生。合金固定组的术后呼吸机使用时间、术后住院时间、肺部感染发生率、术后第5~8天、第9~12天VAS评分明显短于/低于钢丝固定组[(16.0±2.1)h比(18.5±2.3)h、(15±4)d比(17±4)d、2.9%(1/35)比18.9%(7/37)、(0.9±0.5)分比(1.6±0.6)分、(0.3±0.3)分比(1.1±0.5)分],差异均有统计学意义(均P<0.05)。结论通过钛镍合金钢板固定胸骨有助于减少胸骨哆开,减轻术后疼痛,加快术后恢复。Objective To observe the role of titanium and nickel alloy in fixing sternum bone and preventing sternal dehiscence in senile patients undergoing off-pump coronary artery bypass grafting operation.Methods From May 2013 to May 2019,72 senile patients undergoing off-pump coronary artery bypass grafting were enrolled at First Affiliated Hospital of Gannan Medical University;37 patients had traditional sternum fixation using steel wire(steel wire group)and 35 patients had titanium-nickel alloy plate fixation(titanium-nickel alloy group).Operation time,postoperative mechanical ventilation time and hospitalization time,Visual Analogue Scale(VAS)score,intra-aortic balloon pump use rate,incidence rates of sternal dehiscence,pulmonary infection and incision infection were analyzed.Results There were 4 cases of sternal dehiscence in the steel wire group and the incidence rate was 10.8%(4/37).No sternal dehiscence occurred in the titanium-nickel alloy group.Postoperative mechanical ventilation time and hospitalization time,incidence rate of pulmonary infection,VAS score at 5-8 and 9-12 days after operation in the titanium-nickel alloy group were significantly shorter/lower than those in the steel wire group[(16.0±2.1)h vs(18.5±2.3)h,(15.4±3.5)d vs(17.3±3.6)d,2.9%(1/35)vs 18.9%(7/37),(0.9±0.5)vs(1.6±0.6),(0.3±0.3)vs(1.1±0.5)](all P<0.05).Conclusion Titanium and nickel alloy plate sternum fixation can help reduce sternal dehiscence,relieve pain and accelerate postoperative recovery.

关 键 词：非体外循环冠状动脉旁路移植术 胸骨哆开 钛镍合金 

分 类 号：R654.2[医药卫生—外科学]