封闭式持续负压吸引治疗小儿心脏外科手术后累及胸骨的深部切口感染  

Clinical outcomes of vacuum-assisted closure for deep sternal wound infection after pediatric cardiac surgery

作　　者：林野[1] 李守军[1] Lin Ye;Li Shoujun(Department of Cardiovascular Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,心血管疾病国家重点实验室,阜外心血管病医院小儿心脏外科中心,北京市100037

出　　处：《临床小儿外科杂志》2020年第9期806-809,共4页Journal of Clinical Pediatric Surgery

基　　金：十三五国家重点研发计划(编号:2017YFC1308100)。

摘　　要：目的对使用封闭式持续负压吸引(vacuum-assisted closure,VAC)治疗小儿心脏外科手术后累及胸骨深部切口感染(deep sternal wound infection,DSWI)的临床经验进行总结。方法2017年2月至2020年2月,中国医学科学院阜外心血管病医院小儿心脏外科中心共收治6例年龄小于7岁的经胸骨正中切口手术后发生DSWI的患者,均接受封闭式持续负压吸引治疗。其中男4例,女2例;年龄15天至5岁,平均(2.18±1.85)岁;体质量3~19 kg,平均(10.43±5.96)kg。患儿切口感染均累及胸骨或纵膈组织,伤口裂开同时伴有不同程度的胸骨切割或纵膈感染,均需入手术室行清创手术。患儿基础心脏疾病包括:完全型大动脉转位1例,法洛四联症2例,右室双出口1例,室间隔缺损1例,完全型肺静脉异位引流1例;伤口分泌物培养阳性3例(金黄色葡萄球菌1例,表皮葡萄球菌2例)。选择VAC治疗的原因为:伤口感染严重、渗出量多或者患儿依从性差无法耐受床旁换药。本组6例分别于术后第7~20天给予封闭式负压吸引治疗。方法如下:开放原手术切口直至充分显露胸骨,彻底清除切口内的坏死组织,修剪出与切口大小一致的黑色泡沫敷料填充于胸骨表面,最后用贴膜密闭创口,于渗出较多处开口,接负压吸引装置,初始压力为50 mmHg,治疗模式为持续吸引,吸引强度为轻到中级强度,年龄5岁以上患儿如果渗出较多,可以将压力增加至75 mmHg,观察每日伤口引流量及颜色,待引流液少于10 mL/d、引流液颜色变淡呈浆液性,无脓性分泌物,肉芽新鲜后入手术室行清创缝合术,术后定期观察伤口。结果6例中无一例住院期间死亡。使用VAC治疗时间为5~7 d,在使用VAC治疗后伤口渗液明显减少,颜色变淡;患儿体温下降,血白细胞计数逐渐恢复正常,6例均在完成一个VAC治疗周期后进手术室接受清创手术,其中5例顺利保留胸骨并完成了二期清创缝合手术,另外1例由于发现感�Objective To retrospectively evaluate the clinical outcomes of vacuum-assisted closure(VAC)for deep sternal wound infection(DSWI)after pediatric cardiac surgery.Methods From February 2017 to February 2020,6 DSWI children aged under 7 years after median sternotomy underwent VAC.There were 4 boys and 2 girls with an average age of(2.18±1.85)years(15 days to 5 years)and an average body weight of(10.43±5.96)(3-19)kg.The underlying cardiac diseases included complete transposition of the great arteries(n=1),tetralogy of Fallot(n=2),double outlet of right ventricle(n=1),ventricular septal defect(n=1),TAPVC(n=1),1 case of neonatal patient,wound secretion culture positive(n=3)[including Staphylococcus aureus(n=1)and Staphylococcus epidermidis(n=2)].The reasons for selecting VAC were severe wound infection,excessive exudation,or poor compliance of not tolerating bedside dressing changes.Six cases underwent VAC at Day 7-20 post-operation.The specific procedure was as follows:opening original surgical incision until a full exposure of sternum,completely removing necrotic tissue,trimming a black foam dressing of the same size as incision,filling the surface of sternum and finally sealing wound with a film.The initial pressure was 50 mmHg.The treatment mode was continuous suction with a light-to-medium strength.For children aged over 5 years with massive,the pressure might be elevated to 75 mmHg.Daily volume and color of wound drainage were recorded.After the daily volume of drainage fluid became<10 ml,color turned serous and non-purulent and granulation was fresh.Wound debridement and suturing were performed and regular postoperative observations followed.Results None of them died during hospitalization.After a course of VAC for 5-7 days,wound exudate decreased markedly,color became pale,body temperature declined and white blood cell count gradually normalized.Six cases returned to operating room for wound debridement.In 5 cases,a second debridement was successful and sternum preserved.In another case,due to late infection

关 键 词：胸骨正中切口 切口感染 封闭式持续负压吸引 

分 类 号：R729[医药卫生—儿科] R625.2[医药卫生—临床医学]