心脏直视手术后延迟关胸的探讨

Delayed sternal closure after open-heart operation

目的 本文旨在探讨延迟关胸的病理学基础、操作方法 及延迟关胸的适应证.对象我科自1999年9月～2000年10月,共有24例患者接受延迟关胸治疗,平均年龄为37.8岁.其中17例痊愈,7例死亡;延迟关胸时间为2～4.5 d,平均2.8 d.结论 心肌细胞、心肌细胞间质及肺间质的一过性水肿,将导致心肌收缩力减弱;胸壁等软组织在牵拉后也会出现一定程度的水肿.对于部分患者,勉强拉闭胸骨会出现'压逼综合征',危及生命.良好地掌握延迟关胸的适应证及关胸指征可以有效地降低心脏直视手术的死亡率.

Abstract:Objective To find the etiology ofdelayed sternal closure, operating method and the indica-tors of delayed sternal closure. Methods and ResultsFrom Sept. 1999 to Oct. 2000, there were 24 patientsreceived delayed sternal closure, average age was 37.8year. 17 patients survived and 7 patients died. Delayedclosure time was 2 to 4. 5 days with average 2. 8 days.Conclusions Myocardium and lung mesenchyme celledema could decrease the heart contract ability and respi-ration functions. For some patients, reluctant sternal do-sure could result in 'Squeeze syndrome',which could in-crease operation mortality. Delayed sternal closure ac-cording to the indicators could decrease mortality effec-tively.