冠状动脉搭桥术后胸骨哆开的原因分析与诊治

Causes,Diagnosis,and Treatment of Sternal Dehiscence After Coronary Artery Bypass Grafting

目的:探讨冠心病患者冠状动脉搭桥术(CABG)后胸骨哆开的原因、诊断、治疗及预防。方法:回顾分析2001年1月-2011年6月我院CABG术后并发胸骨哆开的病例,总结探讨其病因及预防、早期诊断、治疗经验。结果:期间我院心外科共实施CABG术1 452例,其中11例患者于术后5-11 d出现胸骨哆开,发生率0.76%。11例中10例经二次开胸行胸骨固定术,1例保守胸带外固定,同时积极治疗伴发病及加强支持治疗,全部治愈,伤口平均愈合时间(15.09±4.41)d。结论:术前重视胸骨哆开的预防,术中加强胸骨保护、改进缝合技术,可减少其发生率。对术后胸骨哆开病例早发现、早诊断、及时重新固定,预后良好。

Objective： To explore the causes of sternal dehiscence after coronary artery bypass grafting（CABG）,and to discuss the methods for prevention,early diagnosis,and treatment.Methods： A total of 1 452 cases of CABG,which were performed between January,2001 and June,2011 in our hospital,were retrospectively studied.Results： Eleven cases suffered sternal dehiscence after operation during this period,and the prevalence rate is 0.76%.Ten cases accepted re-suturing procedure and one accepted conservative treatment.All patients discharged with complete wound closure.The average wound healing time was（15.09±4.41） d.Conclusion： Paying more attention to high risk patients,enhancing sternal protection,and improving techniques of sternal fixation in operation are the keys to decrease its prevalence rate.The prognosis may be better if we can diagnose and re-suture sternum earlier.