胸骨正中劈开入路心脏术后并发胸部切口感染危险因素的病例对照研究  

Factors associated with sternal wound infection after open heart surgery via sternotomy:A case-control study

作　　者：陈东升 刘建超[3] 冯泽坤[4] 李双磊 何添[2] 张广良 梁纯 陈犹白 韩岩[2] CHEN Dongsheng;LIU Jianchao;FENG Zekun;LI Shuanglei;HE Tian;ZHANG Guangliang;LIANG Chun;CHEN Youbai;HAN Yan(Chinese PLA Medical School,Beijing 100853,China;Department of Plastic and Reconstructive Surgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of information,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Cardiovascular Surgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Division of Adult Cardiac Surgery,Department of Cardiology,the Sixth Medical Center,Chinese PLA General Hospital,Beijing 100037,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第一医学中心整形修复科,北京100853 [3]解放军总医院第一医学中心卫勤部信息科,北京100853 [4]解放军总医院第一医学中心心脏大血管外科,北京100853 [5]解放军总医院第六医学中心心血管病医学部成人心脏外科,北京100037

出　　处：《解放军医学院学报》2024年第3期245-251,共7页Academic Journal of Chinese PLA Medical School

摘　　要：背景胸骨正中劈开术是开胸心脏手术的常规入路,经此入路行心脏手术的患者术后可并发胸部切口感染(sternal wound infection,SWI),给患者造成巨大的心理和经济负担。目的探索SWI发生的危险因素,积极预防并降低其发病率。方法回顾性分析2011年1月—2021年1月于解放军总医院通过胸骨正中劈开入路行开胸心脏手术患者,筛选发生SWI的病例,并进行1∶4倾向性匹配。通过单因素Cox分析和LASSO回归筛选与SWI发生有关的特征指标,综合专家意见后进行多因素Cox回归确定切口感染的独立危险因素。结果5471例患者中61例在开胸手术后180 d内发生SWI,发病率为1.11%,其中44例为浅表胸骨切口感染,17例为深部胸骨切口感染。病例组男21例,女40例,中位年龄61岁;对照组男110例,女134例,中位年龄59岁。多因素Cox回归分析显示,体质量指数[HR(95%CI):1.07(1.00~1.14),P=0.038]、糖尿病[HR(95%CI):1.87(1.01~3.46),P=0.046]、心肌梗死[HR(95%CI):2.25(1.19~4.26),P=0.013]是SWI的独立危险因素。结论基于解放军总医院病例数据,本研究发现SWI的独立危险因素为糖尿病、高体质量指数和心肌梗死。这些因素可能通过破坏伤口愈合过程、损害组织修复和皮肤屏障完整性以及降低对细菌的抵抗力影响SWI的发生。Background Median sternotomy is a conventional approach for cardiac surgery,and patients undergoing this approach may develop sternal wound infection(SWI),which may bring heavy economic pressure and great psychological burden and pain to patients.Objective To explore the independent risk factors for SWI,so as to lower its incidence and take preventive measures.Methods A retrospective analysis was conducted on patients who underwent open heart surgery through the median sternotomy approach at Chinese PLA General Hospital from January 2011 to January 2021.Cases of SWI were screened and a 1:4 propensity matching was performed.Characteristic variables were screened by univariate Cox analysis and LASSO regression.After considering expert opinions,appropriate variables were selected for multivariate Cox regression analysis.Results Of the 5471 cases,61 cases developed SWI within 180 days after thoracotomy,with a incidence rate of 1.11%,44 of whom were SSWI and 17 were DSWI.In the whole cohort of 305 patients,there were 21 males and 40 females in the case group,with a median age of 61 years,while in the control group,there were 110 males and 134 females,with a median age of 59 years.Multivariate Cox regression analysis showed that body mass index(HR[95%CI]:1.07[1.00-1.14],P=0.047),diabetes(HR[95%CI]:1.87[1.01-3.46],P=0.047),and myocardial infarction(HR[95%CI]:2.25[1.19-4.26],P=0.010)were independently associated with SWI.Conclusion We find that the independent risk factors for SWI are diabetes,increased body mass index,and myocardial infarction.These factors are thought to influence the development of SWI by disrupting wound healing process,impairing tissue repair and skin barrier integrity,and decreasing resistance to bacteria.

关 键 词：胸部切口感染 伤口愈合 危险因素 前正中胸骨劈开术 心脏手术 

分 类 号：R632[医药卫生—外科学]