不同胸骨固定模式在胸骨哆开高危患者心脏手术中的应用  

Application of different sternal fixation models in cardiac surgery for high-risk patients with sternal dehiscence

作　　者：王静[1] 郝爽 张竞超[1] 裴宇[1] 王丽[1] WANG Jing;HAO Shuang;ZHANG Jingchao;PEI Yu;WANG Li(Department of Cardiovascular Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,450052,China)

机构地区：[1]郑州大学第一附属医院心血管外科,郑州450052

出　　处：《临床心血管病杂志》2022年第10期811-817,共7页Journal of Clinical Cardiology

基　　金：国家自然科学基金(No:81700319)。

摘　　要：目的:探讨应用钢丝、钛板和胸骨板3种胸骨固定模式在胸骨哆开高危患者心脏手术中的治疗效果和影响因素。方法:回顾性收集2019年1月—2021年12月连续就诊于郑州大学第一附属医院行正中开胸心脏手术的615例胸骨哆开高危患者的临床资料,其中198例行单纯钢丝环扎术固定胸骨为钢丝组,203例应用钢丝联合钛板固定胸骨为钛板组,214例应用钢丝联合胸骨板固定胸骨为胸骨板组。对比3组围手术期指标、术后胸骨感染、哆开及再次固定情况,采用单因素和多因素logistic回归分析探讨影响胸骨哆开的危险因素。结果:与钢丝组比较,钛板组及胸骨板组关胸时间显著延长,各组间比较差异均有统计学意义(P<0.05)。与钢丝组比较,钛板组及胸骨板组术后24 h引流量、重症监护时间、机械通气时间及术后住院天数均减少,且3组间差异有统计学意义(P<0.001)。术后切口发生感染、胸骨哆开和胸骨再固定情况,钢丝组发生率均高于钛板组和胸骨板组,胸骨板组发生率最低,差异均有统计学意义(P<0.05)。logistic多因素回归分析显示,年龄(OR=1.119,95%CI:1.047~1.196,P=0.001)、吸烟(OR=16.865,95%CI:4.994~56.960,P<0.001)、慢性阻塞性肺疾病(COPD)(OR=4.140,95%CI:1.556~11.014,P=0.004)、肾功能不全(OR=3.952,95%CI:1.236~12.636,P=0.020)、长期使用激素(OR=13.894,95%CI:2.314~83.402,P=0.004)是术后发生胸骨哆开的独立危险因素。结论:年龄、吸烟、COPD、肾功能不全及长期使用激素是高危患者术后发生胸骨哆开的独立危险因素。在正中开胸心脏手术后应用钢丝联合钛板或钢丝联合胸骨板固定胸骨均可减少术后发生胸骨哆开,钢丝联合胸骨板固定胸骨临床效果最好,可加强高危患者心脏外科术后胸骨固定的稳定性,值得推广。Objective:To explore the treatment effect of wire cerclage,titanium plate fixation,and sternal plate fixation in the cardiac surgery of high-risk patients with sternal dehiscence and summarize the application experience.Methods:A retrospective analysis was performed on 615 high-risk patients with sternal dehiscence who underwent surgical treatment in the Department of Cardiovascular Surgery,The First Affiliated Hospital of Zhengzhou University from January 2019 to December 2021,198 cases who underwent traditional steel wires were included in steel wire group,203 cases who received wire and titanium plate fixation were selected as titanium plate group and 214 cases receiving wire and sternal plate fixation were set as sternal plate group.The perioperative indicators,sternal infection,sternal dehiscence and sternal refixation were compared among the three groups.Univariate and multivariate logistic regression analysis were used to investigate the risk factors of sternal dehiscence in high-risk patients undergoing cardiac surgery.Results:Compared with the steel wire group,the chest closure time of the titanium plate group and sternal plate group were significantly prolonged,there were significant differences among the groups(P<0.05).Compared with the steel wire group,the drainage at 24 h after surgery,length of stay in the intensive care unit,duration of mechanical ventilation and hospital stay after cardiovascular surgery in titanium plate group and sternal plate group were less,and there were significant differences among the three groups(P<0.001).The number of the postoperative incision infection,sternal dehiscence,and sternal refixation were lower in the titanium plate group and sternal plate group than that in the steel wire group,the incidence of the sternal plate group was the lowest,with statistically significant differences(P<0.05).Multivariate regression analysis showed that age(OR=1.119,95%CI:1.047-1.196,P=0.001),smoking(OR=16.865,95%CI:4.994-56.960,P<0.001),chronic obstructive pulmonary disease(COPD)(OR=

关 键 词：心脏外科手术 胸骨哆开 术后并发症 

分 类 号：R654.2[医药卫生—外科学]