心脏外科术后深部胸骨伤口感染的危险因素分析

Deep Sternal Wound Infection after Cardiac Surgery

目的分析深部胸骨伤口感染(DSWI)的危险因素和处理方法。方法对2001年1月1日-2006年1月5日在医院接受胸部正中切口直视手术的1123例患者,采用单因素及多因素统计分析。结果8例患者发生DSWI(0.71%),高龄为主要危险因素,对DSWI患者早期彻底清创加局部闭合冲洗,全身应用抗菌药物效果满意。结论DSWI分为急性和慢性,采用的DSWI治疗方法疗效可靠,值得推荐。

OBJECTIVE Deep sternal wound infection （DSWI） is one of the most serious complications after the open heart cardiac surgery. To explore the risk factors and appropriate treatment methods, we performed this study retrospectively. METHODS Between Jan 2001 and Jan 2006, 1123 patients underwent various cardiac surgical procedures via a median sternotomy in the Cardiovascular Center of Beijing Tongren Hospital. These patients were divided into two groups by whether suffered from DSWI. Univariate analyses were performed for possible risk factors, and Logistic regression was used in multivariate analysis. RESULTS Eight among 1123 （0.71%） patients suffered from DSWI. No one died from wound infection. Results from both single variate analysis and multivariate analysis showed that only age significantly associated with DSWI. No other independent risk factors significantly associated with DSWI. Blood culture in acute DSWI group tended to be positive, while in chronic group it tended to be negative. All patients with DSWI were effectively cured. CONCLUSIONS Age is an independent risk factor for DSWI. Early debridement with closed chest catheter irrigation and antibiotics using are strongly recommended as an easy and effective way to treat DWSI. Large-scale multicenter studies are still needed to determine reliable risk factors for DSWI.