心血管手术后胸骨裂开的诊断、治疗与预防

Diagnosis treatment and prevention of sternal dehiscence after cardiovascular surgey

目的探讨心血管手术后胸骨裂开的原因、早期表现、诊断、治疗和预防。方法对12年来5例胸骨裂开患者及时再手术清创,重新固定,有效引流。结果 5例全部治愈,4例愈合时间平均12.3 d(10～14 d),1例换药后3周愈合。结论伤口渗出多,呼吸改变可能为胸骨裂开的早期表现,伤口局部的症状、体征,全身表现和胸部影像学对诊断有重要意义。术中改进胸骨固定技术,提高对具备高危因素患者的重视,积极治疗伴发病,术后防止并发症能降低胸骨裂开的发生率。

Objective To study the causes,early symptoms,diagnosis,treatment and prevention of sternal dehiscence after cardiovascular surgey.Methods 5 cases with sternal dehiscence in the last twelve years were treated with debridement,refixation and effective drainage.Results All 5 patients got cured,the average recovery time was 12.3 days（range 10~14 days）in 4cases,1 case was cured in three weeks later by changing dressing.Conclusion Large effusion from wound and change in breath may be common early symptom of sternal dehiscence.The symptoms and signs of the wound,systemic manifestation,imaging of the chest are very important for the diagnosis.To improve the technique of fixtion in operation,to pay attention to high-risk patients,more positive treatment for the associated disease and more positive treatment for the complications after operation can obviously lower the incidence of stemal dehiscence.