胸骨固定系统在心脏直视手术关胸中的应用效果

Application Effect of Sternum Fixation System in Closing Thoracic Cavity of Open Heart Surgery

目的探讨胸骨固定系统在心脏直视手术关胸中的应用效果。方法选取2016年7月—2017年12月在陕西省人民医院行正中纵劈胸骨心脏直视手术的患者60例,采用随机数字表法分为对照组和观察组,每组30例。对照组患者采用钢丝环扎法关胸,观察组患者采用胸骨固定系统关胸。比较两组患者手术情况[包括主动脉阻闭时间、体外循环(CPB)时间、脱机至缝合完皮肤时间、术后24 h引流量、术后脱呼吸机时间、术后ICU停留时间],术后1、2、3 d及出院时、出院后1个月、出院后3个月静息状态和咳嗽状态疼痛数字评分法(NRS)评分,术后并发症发生率。结果 (1)两组患者主动脉阻闭时间、CPB时间及术后24 h引流量比较,差异无统计学意义(P>0.05);观察组患者脱机至缝合完皮肤时间长于对照组,术后脱呼吸机时间及术后ICU停留时间短于对照组(P<0.05)。(2)时间与方法在静息状态NRS评分、咳嗽状态NRS评分上存在交互作用(P<0.05);时间在静息状态NRS评分、咳嗽状态NRS评分上主效应显著(P<0.05);方法在静息状态NRS评分、咳嗽状态NRS评分上主效应不显著(P>0.05)。观察组患者术后2 d静息状态NRS评分、咳嗽状态NRS评分均低于对照组(P<0.05)。(3)两组患者术后胸骨哆开、胸骨创口深部感染、胸骨创口表面感染发生率及创口问题二次手术者所占比例比较,差异无统计学意义(P>0.05)。结论与钢丝环扎法相比,胸骨固定系统能有效缩短心脏直视手术患者术后脱呼吸机时间及ICU停留时间,缓解患者术后短期内疼痛程度,安全性较高,但其可能延长脱机至缝合完皮肤时间。

Objective To explore the application effect of sternum fixation system in closing thoracic cavity of open heart surgery. Methods A total of 60 patients underwent median longitudinal thoracic open heart surgery in Shaanxi Provincial People's Hospital from July 2016 to December 2017 were divided into control group and observation group according to random number table method,each with 30 cases. Patients in control group used wire cerclage for closing the thoracic cavity, while patients in observation group used sternum fixation system for closing the thoracic cavity. Operation related indicators (including aortic occlusion time,CPB time,time from weaning to skin suturing,24-hour drainage after operation,offventilator time after operation,ICU stays after operation),resting NRS score and cough NRS score 1 day,2 days and 3 days after operation,1 month and 3 months after discharge,and incidence of postoperative complications were compared between the two groups. Results (1)There was no statistically significant difference in aortic occlusion time,CPB time or 24- hour drainage after operation between the two groups(P>0.05);time from weaning to skin suturing in observation group was statistically significantly longer than that in control group,while off-ventilator time after operation and ICU stays after operation in observation group were statistically significantly shorter than those in control group(P<0.05).(2)There was statistically significant interaction in resting NRS score and cough NRS score between time and method(P<0.05);main effect of time was statistically significant in resting NRS score and coughing NRS score(P<0.05);main effect of method was not statistically significant in resting NRS score or cough NRS score(P>0.05). Resting NRS score and coughing NRS score in observation group were statistically significantly lower than those in control group 2 days after operation(P<0.05).(3)There was no significant difference in incidence of sternal dehiscence,deep infection of sternal wound or surface infection,or proportion of patients underwent secondary surgery due to wound problems between the two groups(P>0.05). Conclusion Compared with wire cerclage,sternum fixation system can effectively shorten off-ventilator time and ICU stays after open heart surgery,alleviate the short-time pain after operation,with relatively high safety,but it may prolong the time from weaning to skin suturing.