再生氧化纤维素在严重骨质疏松体外循环手术胸骨止血中的作用

Role of oxidized regenerated cellulose in the hemostasis of severe sternal osteoporosis during cardiopulmonary bypass

背景:严重骨质疏松患者正中开胸胸骨出血较多,尤其是体外循环下手术存在凝血功能障碍,更加重了术中及术后出血。目的:与常规胸骨止血材料骨蜡对比,观察再生氧化纤维素在减少严重骨质疏松患者体外循环术后胸骨出血和预防胸骨切口感染中的作用。方法:84例行正中开胸体外循环心脏手术的严重骨质疏松患者,随机分成2组。再生氧化纤维素组胸骨创面及骨髓腔内填充覆盖再生氧化纤维素,对照组常规应用医用骨蜡。记录两组术后1d引流量、总引流量、拔引流管时间、总输血量、切口拆线时间、术后持续发热时间、平均住院时间及术后胸骨切口愈合情况,出院随访6个月。结果与结论:两组术后1d引流量、总引流量、拔引流管时间、总输血量及平均住院时间差异有显著性意义(P<0.05),再生氧化纤维素组更有优势。随访6个月中,再生氧化纤维素组未出现胸骨切口排出异物情况,对照组中有4例出现骨蜡排出。提示再生氧化纤维素可应用于严重骨质疏松患者体外循环后胸骨止血,近远期疗效确切,并在胸骨感染方面具有一定预防作用。

BACKGROUND：Patients with serious osteoporosis have more bleeding volume than those without osteoporosis during cardiac surgery with cardiopulmonary bypass.OBJECTIVE：To study the efficacy of oxidized regenerated cellulose on reducing post-cardiopulmonary bypass sternal bleeding and preventing sternal infection in patients with severe osteoporosis.METHODS：Eighty-four cases of severe osteoporosis undergoing open heart surgery were randomly divided into oxidized regenerated cellulose group and control group.The sternal wound and bone marrow cavity of the oxidized regenerated cellulose group was filled with oxidized regenerated cellulose,and that of the control group was with medical bone wax.Drainage volume at the first postoperative day,total drainage volume,time of draining tube,blood transfusion volume,suture removal time,duration of persistent fever,average hospital staying,postoperative sternal wound healing were recorded and observed,and all the patients were follow-up for 6 months.RESULTS AND CONCLUSION：The comparison between two groups in the drainage volume at the first postoperative day,the total drainage volume,time of draining tube,the volume of blood transfusion and average hospital staying was significantly different（P 0.05）.During the follow-up,there was no case of discharging the foreign body from sternal wound in the oxidized regenerated cellulose group and 3 cases of discharging bone wax in the control group.Oxidized regenerated cellulose can be used in reducing bleeding and preventing sternal infection in patients with severe sternal osteoporosis after cardiopulmonary bypass.The short-and long-term efficacy is reliable.