心脏手术中胸骨正中切口胸骨断面使用骨蜡填塞止血必要性的探讨

Necessity of Bone Wax Stanching Bleeding at Sternal Edge in Patients With Cardiac Surgery by Median Sternotomy

目的:分析在心脏手术中,骨蜡用于胸骨正中切口胸骨断面填塞止血的必要性。方法:连续入选2011-01至2014-12期间共445例患者,其中210例患者的胸骨断面使用骨蜡(骨蜡组),235例患者的胸骨断面未使用骨蜡(无骨蜡组)。分别比较两组患者的二次开胸止血情况以及12小时、24小时及总的引流量,关胸时间和输血率。结果:骨蜡组和无骨蜡组分别有2例和1例患者二次开胸止血,但与骨髓腔出血无关。两组患者的12小时、24小时及总引流量分别为(451±240)ml和(483±238)ml、(615±304)ml和(639±285)ml、(842±467)ml和(842±364)ml(P均>0.05)。骨蜡组和无骨蜡组关胸时间分别为(68.0±23.0)min和(66.0±19.0)min(P>0.05)。骨蜡组和无骨蜡组总输血率分别是21%和19%(P>0.05)。结论:胸骨断面骨蜡的使用不会显著减少关胸后的引流量,也不会影响关胸速度。应舍弃骨蜡在胸骨断面止血中的应用。

Objective： To explore the necessity for application of bone wax stanching bleeding at sternal edge in cardiac surgery by median sternotomy. Methods： A total of 445 patients who receive cardiac surgery by the same surgeon performing median sternotomy in our hospital from 2011-01 to 2014-12 were studied. According to application of bone wax stanching bleeding, the patients were divided into 2 groups： Bone wax group, n=210 and Non-bone wax group, n=235. Re-thoracotomy for hemostasis, 12 h, 24 h and total draining volume after the operation and time of closing incision were compared between 2 groups. Results： There were 2 patients and 1 patient received re-thoracotomy for hemostasis in Bone wax group and Non-bone wax group respectively, which was not related to bone marrow cavity bleeding. In Bone wax group and Non-bone wax group, the draining volume at 12 h post-operation were （451 ± 240） ml vs （483 ±238） ml, at 24 h post-operation were （615±304） ml vs （639± 285） ml and the total volume were （842 ± 467） ml vs （842 ± 364） ml, all P〉0.05; the time of closing incision were （68.0 ± 23.0 ） rain vs （66.0 ± 19.0 ） min, P〉0.05; the total transfusion rates were 21% vs 19%, P〉0.05. Conclusion： Application of bone wax at sternum edge could neither affecting the drainage nor the speed of closing incision in cardiac surgery and therefore, it might be given up.