心脏外科术后不同类型深部胸骨切口感染的临床表现及病原学特点

Clinical Manifestations and Pathogenic Characteristics of Different Types of Deep Sternal Wound Infection in after Cardiac Surgery

目的探讨心脏外科术后不同类型的深部胸骨切口感染(DSWI)的临床表现及病原学特点。方法回顾性分析2012年1月至2014年12月中国医科大学航空总医院心胸外科84例接受肌瓣修复重建手术治疗的心脏手术后DSWI患者的临床资料。结果 84例DSWI患者平均年龄(54.6±14.8)岁,其中Ⅱ型DSWI患者最多见(49/84,58.3%)。Ⅰ型和Ⅱ型DSWI患者均呈现出典型的临床表现,早期X线/CT扫描可发现纵膈增宽(P<0.01)。部分Ⅲ型DSWI患者仅表现为手术区域局部症状。DSWI患者最常见的病原菌为革兰阴性杆菌(GNB),占54.8%,虽然3种类型DSWI的病原学结果无统计学差异(P>0.05),但Ⅰ型DSWI患者GNB更常见,Ⅱ型DSWI患者更易并发混合型感染。结论不同类型的DSWI患者具有不同的临床特点,制定DSWI的防治策略要紧密结合临床表现和当地的病原学特征。

Objective To investigate the clinical features and pathogenic characteristics of different types of deep sternal wound infection in different types after cardiac surgery. Methods A retrospective study was performed. From January 2012 to December 2014,84 patients with secondary DSWI after cardiac surgery underwent the pectoralis major muscle flap transposition in our department were recruited for the study. Results The average age of 84 patients with DSWI was 54.6±14.8 years old,of which typeⅡDSWI patients were the most common（49/84,58.3%）. Both typeⅠand typeⅡ DSWI patients showed typical clinical manifestations and early chest X-ray or Computerized tomography（CT）showed mediastinal widening（P〈0.01）. Some patients with type Ⅲ DSWI showed only local symptoms of surgery. The organisms most commonly isolated in patients with DSWI were gram gram-negative bacilli（GNB,54.8%）. Although there was no significant difference between the 3 types of DSWI patients（P〉0.05）,but the pathogenic results of the 3 types of those DSWI patients showed such a trend：typeⅠ DSWI patients with GNB is was more common,and typeⅡDSWI patients was more prone to complicated infection. Conclusion Different types of DSWI may display different features,the prevention and treatment of DSWI should be closely combined with the clinical manifestations and local pathogenic characteristics.