两种方法治疗心脏术后不同程度胸骨感染的效果分析  

Analysis on the effect of two methods in different degrees deep sternal wound infection after undergoing cardiac surgery

作　　者：刘新宾 王新 赵忠[1] 高智强[1] 鲍黎明 高扬[1] 张国华[1] Liu Xinbin;Wang Xin;Zhao Zhong;Gao Zhiqiang;Bao Liming;Gao Yang;Zhang Guohua(Depaamem of Cardiac Surgery,Aerospace Central Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院心外科,北京100049

出　　处：《中华胸心血管外科杂志》2021年第9期553-556,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨两种胸大肌填充方法治疗心脏术后不同程度胸骨深部切口感染的效果。方法2014年4月至2019年12月期间共收治128例心脏术后胸骨深部切口感染患者,其中男88例,女40例;年龄(59.1±10.7)岁。轻症72例,重症56例,分别实施胸大肌内侧肌瓣对接法(66例,内侧对接组)和胸大肌外侧肌瓣翻转法(62例,外侧翻转组)。观察记录两组术后住院时间、胸腔引流管留置时间、再次手术率、肺部感染发生率、远期胸廓稳定性等,比较治疗效果。结果轻症患者中,轻症内侧对接组与轻症外侧翻转组在术后住院时间[(14.2±4.7)天对(17.1±3.9)天]、胸腔引流管留置时间[(6.2±1.7)h对(9.1±2.9)h]、再手术率[2.4%(1/42)对6.7%(2/30)]、肺部感染发生率[14.3%(6/42)对23.3%(7/30)]和远期胸廓稳定性[73.8%(31/42)对43.3%(13/30)]方面差异均有统计学意义(P<0.05),轻症内侧对接组效果更优。重症患者中,重症内侧对接组与重症外侧翻转组在术后住院时间[(24.2±7.2)天对(20.1±3.5)天]、胸腔引流管留置时间[(20.2±6.6)h对(13.2±3.1)h]、再手术率[20.8%(5/24)对12.5%(4/32)]、肺部感染发生率[41.7%(10/24)对31.3%(10/32)]和远期胸廓稳定性[25.0%(6/24)对68.8%(22/32)]方面差异均有统计学意义(P<0.05),重症外侧翻转组效果更优。结论轻症心脏术后胸骨深部切口感染应用胸大肌内侧肌瓣对接法较外侧肌瓣翻转法住院时间少、再手术率低、治疗效果好,在重症组两种治疗效果则相反。Objective To analysis the effect of two methods of transposition of pectoralis major in different degrees deep sternal wound infection(DSWI)after undergoing cardiac surgery.Methods 128 patients with DSWI after cardiac surgery were treated,72 were mild,and 56 were severe.66 cases of pectoralis major muscle flap docking method(medial muscle flap docking group)and 62 cases of lateral pectoralis major muscle flap turnover method(lateral muscle flap turnover group)were implemented respectively.Drainage tube indwelling time,reoperation rate,incidence of lung infection,long-term thoracic stability and other aspects were observed to compared the treatment effect.Results In the mild patients,the medial muscle flap docking group and the lateral muscle flap turnover group were compared(P<0.05).The postoperative hospital stay[(14.2±4.7)days vs.(17.1±3.9)days],drainage tube retention time[(6.2±1.7)h vs.(9.1±2.9)h],and reoperation rate(2.4%vs.6.7%),the incidence of lung infection(14.3%vs.23.3%),long-term thoracic stability[73.8%(31/42)vs.43.3%(13/30)].In the severe patients,the medial muscle flap docking group and the lateral muscle flap turnover group were compared.The postoperative hospital stay[(24.2±7.2)days vs.(20.1±3.5)days],drainage tube retention time[(20.2±6.6)h vs.(13.2±3.1)h],reoperation rate(20.8%vs.12.5%),incidence of pulmonary infection(41.7%vs.31.3%),long-term thoracic stability[25.0%(6/24)vs.68.8%(22/32)].The differences of the indicators in each group were significant,P<0.05.In the mild group,each index of the pectoralis major medial muscle flap docking method was superior to the lateral muscle flap turnover method,but the treatment results of the two methods in the severe group were opposite.Conclusion Patients with mild deep DSWI treated with medial pectoralis major muscle flap docking and suture have less hospital stay,less reoperation rate,less complications and better treatment effect than reverse lateral pectoralis major muscle flap turnover.But the two treatments in the severe DSWI have the oppo

关 键 词：心脏外科手术 胸骨深部切口感染 胸大肌 

分 类 号：R654.2[医药卫生—外科学]