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重视胸骨切开术后胸骨深部伤口感染的预防和处理

官浩 陈阳

官浩, 陈阳. 重视胸骨切开术后胸骨深部伤口感染的预防和处理[J]. 中华烧伤与创面修复杂志, 2024, 40(2): 125-130. DOI: 10.3760/cma.j.cn501225-20231212-00235.
引用本文: 官浩, 陈阳. 重视胸骨切开术后胸骨深部伤口感染的预防和处理[J]. 中华烧伤与创面修复杂志, 2024, 40(2): 125-130. DOI: 10.3760/cma.j.cn501225-20231212-00235.
Guan H,Chen Y.Pay attention to the prevention and treatment of deep sternal wound infection after sternotomy[J].Chin J Burns Wounds,2024,40(2):125-130.DOI: 10.3760/cma.j.cn501225-20231212-00235.
Citation: Guan H,Chen Y.Pay attention to the prevention and treatment of deep sternal wound infection after sternotomy[J].Chin J Burns Wounds,2024,40(2):125-130.DOI: 10.3760/cma.j.cn501225-20231212-00235.

重视胸骨切开术后胸骨深部伤口感染的预防和处理

doi: 10.3760/cma.j.cn501225-20231212-00235
基金项目: 

教育部中国高校产学研创新基金 2021JH030

详细信息
    通讯作者:

    官浩,Email:guanhao2020@yeah.net

Pay attention to the prevention and treatment of deep sternal wound infection after sternotomy

Funds: 

Industry-University-Research Innovation Fund of Ministry of Education of China 2021JH030

More Information
  • 摘要: 胸骨深部伤口感染(DSWI)是心脏手术后潜在且灾难性的并发症之一。尽管临床上采用了更小的切口、常规预防性使用抗生素和优化血糖管理等措施,但DSWI的发病率依然在1%~5%波动。DSWI在发生初期的症状和体征均不明显,致使临床医师的干预介入偏晚。DSWI一旦未被及时处理,患者病死率极高。因此,及早预防、诊断和适当处理对于防止DSWI进一步发展至致命的结局非常重要。鉴于DSWI的临床危害性和治疗的复杂性,故本文重点探讨和分享在各个环节中预防DSWI发生的经验、发生后的重建修复策略,以引起广大同行对DSWI的重视。

     

  • 参考文献(26)

    [1] BurnettCM, RosemurgyAS, PfeifferEA. Life-threatening acute posterior mediastinitis due to esophageal perforation[J]. Ann Thorac Surg, 1990,49(6):979-983. DOI: 10.1016/0003-4975(90)90882-7.
    [2] JaworskyD, ReynoldsS, ChowAW. Extracranial head and neck infections[J]. Crit Care Clin, 2013,29(3):443-463. DOI: 10.1016/j.ccc.2013.03.003.
    [3] CherveniakovA, CherveniakovP. Surgical treatment of acute purulent mediastinitis[J]. Eur J Cardiothorac Surg, 1992,6(8):407-410; discussion 411. DOI: 10.1016/1010-7940(92)90064-5.
    [4] SongYY, ChuWL, SunJC, et al. Review on risk factors, classification, and treatment of sternal wound infection[J]. J Cardiothorac Surg, 2023,18(1):184. DOI: 10.1186/s13019-023-02228-y.
    [5] PhoonPHY, HwangNC. Deep sternal wound infection: diagnosis, treatment and prevention[J]. J Cardiothorac Vasc Anesth, 2020,34(6):1602-1613. DOI: 10.1053/j.jvca.2019.09.019.
    [6] ChanM, YusufE, GiulieriS, et al. A retrospective study of deep sternal wound infections: clinical and microbiological characteristics, treatment, and risk factors for complications[J]. Diagn Microbiol Infect Dis, 2016,84(3):261-265. DOI: 10.1016/j.diagmicrobio.2015.11.011.
    [7] BalachandranS, LeeA, DenehyL, et al. Risk factors for sternal complications after cardiac operations: a systematic review[J]. Ann Thorac Surg, 2016,102(6):2109-2117. DOI: 10.1016/j.athoracsur.2016.05.047.
    [8] KrasivskyiI, IvanovB, EghbalzadehK, et al. Sex-associated differences in short-term outcomes in patients with deep sternal wound infection after open-heart surgery[J]. J Clin Med, 2022,11(24):7510. DOI: 10.3390/jcm11247510.
    [9] PanL, MoR, ZhouQ, et al. Deep sternal wound infection after cardiac surgery in the Chinese population: a single-centre 15-year retrospective study[J]. J Thorac Dis, 2017,9(9):3031-3037. DOI: 10.21037/jtd.2017.08.41.
    [10] McGregorWE, TrumbleDR, MagovernJA. Mechanical analysis of midline sternotomy wound closure[J]. J Thorac Cardiovasc Surg, 1999,117(6):1144-1150. DOI: 10.1016/s0022-5223(99)70251-5.
    [11] TeppaR, SudeNS, KaranamVPK, et al. Relevance of subcutaneous fat thickness as a risk factor for surgical site infections in abdominal surgeries[J]. Cureus, 2022,14(1):e20946. DOI: 10.7759/cureus.20946.
    [12] MagalhãesDMS, DeiningerMO, OliveiraOG, et al. Deep sternal wound infection after beating heart coronary artery bypass surgery with routine use of skeletonized bilateral internal thoracic artery[J]. Braz J Cardiovasc Surg, 2023,38(4):e20210607. DOI: 10.21470/1678-9741-2021-0607.
    [13] SoferD, GurevitchJ, ShapiraI, et al. Sternal wound infections in patients after coronary artery bypass grafting using bilateral skeletonized internal mammary arteries[J]. Ann Surg, 1999,229(4):585-590. DOI: 10.1097/00000658-199904000-00020.
    [14] GattiG, PappalardoA, ChocronS, et al. Validation and performance comparison of two scoring systems created specifically to predict the risk of deep sternal wound infection after bilateral internal thoracic artery grafting[J]. Surg Infect (Larchmt), 2020,21(5):433-439. DOI: 10.1089/sur.2019.252.
    [15] JaiswalA, TrubyLK, ChichraA, et al. Impact of obesity on ventricular assist device outcomes[J]. J Card Fail, 2020,26(4):287-297. DOI: 10.1016/j.cardfail.2019.10.001.
    [16] VosRJ, Van PutteBP, KloppenburgGTL. Prevention of deep sternal wound infection in cardiac surgery: a literature review[J]. J Hosp Infect, 2018,100(4):411-420. DOI: 10.1016/j.jhin.2018.05.026.
    [17] KaulP. Sternal reconstruction after post-sternotomy mediastinitis[J]. J Cardiothorac Surg, 2017,12(1):94. DOI: 10.1186/s13019-017-0656-7.
    [18] LazarHL, SalmTV, EngelmanR, et al. Prevention and management of sternal wound infections[J]. J Thorac Cardiovasc Surg, 2016,152(4):962-972. DOI: 10.1016/j.jtcvs.2016.01.060.
    [19] LeeDY, EoS, LimS, et al. Successful pedicled vertical rectus abdominis myocutaneous flap reconstruction with negative-pressure wound therapy for deep sternal wound infection: a case report and comprehensive review[J]. Front Surg, 2023,10:1268555. DOI: 10.3389/fsurg.2023.1268555.
    [20] BotianuPVH. Current indications for the intrathoracic transposition of the omentum[J]. J Cardiothorac Surg, 2019,14(1):103. DOI: 10.1186/s13019-019-0924-9.
    [21] ErnertC, KielsteinH, AzatyanA, et al. Extended arc of rotation of Latissimus Dorsi Musculocutaneous Flap providing well-vascularized tissue for reconstruction of complete defects of the sternum: an anatomical study of flap pedicle modification[J/OL]. Clin Hemorheol Microcirc, 2023(2023-09-16)[2023-12-12]. https://pubmed.ncbi.nlm.nih.gov/37742631/.DOI: 10.3233/CH-238115.[published online ahead of print].
    [22] LoS, HutsonK, HallamMJ, et al. The importance of early flap coverage in deep sternal wounds[J]. Ann Plast Surg, 2014,73(5):588-590. DOI: 10.1097/SAP.0b013e318284084b.
    [23] CabbabeEB, CabbabeSW. Immediate versus delayed one-stage sternal débridement and pectoralis muscle flap reconstruction of deep sternal wound infections[J]. Plast Reconstr Surg, 2009,123(5):1490-1494. DOI: 10.1097/PRS.0b013e3181a205f9.
    [24] BanjanovicB, Haxibeqiri KarabicI, StrausS, et al. Our experiences in the treatment of anterior chest wall infections (2015-2021)[J]. Mater Sociomed, 2022,34(2):142-148. DOI: 10.5455/msm.2022.34.142-148.
    [25] van WingerdenJJ, UbbinkDT, van der HorstCM, et al. Poststernotomy mediastinitis: a classification to initiate and evaluate reconstructive management based on evidence from a structured review[J]. J Cardiothorac Surg, 2014,9:179. DOI: 10.1186/s13019-014-0179-4.
    [26] 张万福, 徐婧, 张敬群, 等. 胸骨切开术后继发伴胸骨骨髓炎和/或纵隔炎创面的围手术期处理及其临床效果[J].中华烧伤与创面修复杂志,2024,40(2):151-158. DOI: 10.3760/cma.j.cn501225-20231028-00141.
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  • 收稿日期:  2023-12-12

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