开胸术后胸骨骨髓炎治疗的Meta分析

Meta-analysis of the main treatments for infected sternal wounds after thoracic surgery

目的应用Meta分析方法探讨开胸术后胸骨骨髓炎主要治疗方法的疗效。方法采用Meta分析的方法,检索国内外文献数据库,对国内外学者自1966年至2011年公开发表的有关开胸术后胸骨骨髓炎治疗的308篇文献进行综合定量分析,将死亡率、住院时间作为衡量指标。结果经筛选有10篇文献入选,与保守治疗相比,开胸术后出现胸骨骨髓炎的患者在清创后采用负压治疗的死亡率减少了66%(95%CI20%～57%)、住院时间减少了9.24d(95%CI-10.98～-7.50);采用皮瓣修复术治疗的死亡率减少了95%(95%CI1%～21%)、住院时间缩短了8.65d(95%CI-10.31～-6.99);而负压治疗与皮瓣修复术治疗比较,负压治疗的住院时间缩短了2.77d(95%CI-3.23～-0.31),而两组的死亡率差异无统计学意义(P=0.12,>0.05)。结论清创后行负压治疗、皮瓣修复术等方法作为目前治疗开胸术后胸骨骨髓炎的主要治疗方法,与传统治疗方法相比可以降低死亡率,缩短住院时间。负压治疗相对于皮瓣修复术可以缩短住院时间。

Objective To analyze the effects of the main treatments for infected sternal wounds after thoracic surgery with Meta-analysis.Methods Electronic databases from January 1966 to March 2011 about randomized controlled trial of infected sternal wounds after thoracic surgery were collected and Meta-analysis of these randomized controlled trial was used, the measurement index being morbidity and length of stay. Results A total of 10 trials were included. Compared with conventional treatment,morbidity of negative pressure wound therapy after debridement for infected sternal wounds reduced by 66% （95% CI 20%-57%,P 0.001）, and the length of stay reduced by 9.24 days（95% CI -10.98--7.50,P 0.001）. While through the reconstruction by flap treatment, the morbidity was reduced by 95% （95% CI 1%-21%,P 0.001）, and the length of stay was reduced by 8.65 days （95% CI -10.31--6.99, P 0.001）. Compared with the flap reconstruction, negative pressure wound therapy reduced the length of stay by 2.77 days （95% CI -3.23--0.31, P= 0.02）. There was not statistically significant difference about the morbidity of treatment between flap reconstruction and negative pressure wound therapy groups （P=0.12）.Conclusions Compared with conventional treatment,both flap reconstruction and negative pressure wound therapy after debridement can reduce the morbidity and mortality of infected sternal wounds after thoracic surgery,and negative pressure wound therapy may reduce the length of stay of infected sternal wounds.