心脏外科术后纵膈感染的临床特点

The Clinical Chaar cteristic of Mediastinitis Relve ant to Cardiac Surgery Prco edures via Median Sternal Incisoi n

目的：总结经胸骨正中切口行心脏手术后发生纵隔感染的诊治经验。方法：对2005年9月～2012年10月，我科47例胸骨正中切口心脏术后纵隔感染病人的临床表现，诊断方法，鉴别诊断，治疗手段，及预后进行回顾分析，10例行胸骨固定，纵膈冲洗，其中2例行胸大肌肌瓣填充修补，37例局部切开引流换药，47例患者发热6例，无发热41例，患者中毒症状6例，无中毒症状者41例，47例患者均有切口渗出和胸骨不稳定，切口分泌物培养18例阳性，其中MRSA 2例，根据药物敏感试验结果调整抗生素。结果：死亡6例，死亡率12％，见于中毒症状者和MRSA感染者。余患者均存活。随访1～5年，无远期死亡，感染复发3例。结论：胸骨正中切口行心脏手术后，纵膈感染是一种危及生命的严重并发症，早期清创、开放引流冲洗是有效的治疗方法。严重感染者预后极差。

Objective：To summarize the experience of diagnosis and treatment of mediastinitis relevant to cardiac surgery procedures via median sternal incision .Method s：From September 2005 to October 2012, mediastinitis developed in 47 （ 2.8%） of 1645 consecu-tive cardiac surgery procedures via median sternal incision .We reviewed the variation of clinical characteristics、diagnostic approach 、dif-ferential diagnosis、treatment approch and the prognosis in these patients .10 patients underwent extensive sternal and soft tissue debride-ment and dosed mediastinal irrigation with antiseptic solution and drainage through tubes .Two of them were given plastics procedures using rectus abdominus flaps or pectoralis major muscle flaps ,Only local drainage and irrigation with antiseptic solution were given in 37 be-cause of the mild infection .6 patients of 47 patients had a fever , the others had no fever , All of 47 patients had incision exudation and sternum unstability ,Samples of sternal drainage and arterial blood were sent for culture to establish a diagnosis and to tailor antimicrobial therapy .18 patients had positive culture , 2 patients of them had MRSA infection , Antibiotics were selected based on the culture and sen-sitivity data .Results：There were 6 hospital death （12.7 %） in toxic symptom and MRSA infection , there was no death in other patiens during the follow-up of 1-5 years,3 patients had infection recurrence .Conclusion ：Mediastinitis associated with cardiac surgery via sternal incision is a life -threatening condition with a high mortality rate , Earlier recognition and prompt surgical intervention are impor-tant.Immediately drainage , debridement and mediastinal irrigation could improve the outcome of this dreadly complication .The prognosis of serious infection patients were worse.