Boeken U, Eisner J, Feindt P, Petzold T H, Schulte H D, Gams E
Department of Thoracic and Cardiovascular Surgery, Heinrich Heine University Hospital, Düsseldorf, Germany.
Thorac Cardiovasc Surg. 2001 Feb;49(1):45-8. doi: 10.1055/s-2001-9924.
Former studies on sternal wound infections indicate predisposing factors like diabetes, obesity, use of bilateral internal mammary grafts, impaired renal function and reoperation. We wanted to evaluate whether the time of resternotomy for postoperative bleeding has any influence on the development of a sternal wound infection and other complications.
In our department, 12,315 patients underwent median sternotomy for cardiac surgery between 1987 and 1998. We analyzed the clinical data of all patients which were reoperated on for postoperative bleeding, especially patients with subsequent operations caused by sternal wound infections. All data were compared by T-test respectively chi2-test, and p<0.05 was regarded as significant.
406 of the 12,315 patients were re-explored because of postoperative bleeding (3.3%). 57 (14%) of these patients died in the postoperative period of non-infectious complications. The remaining patients were divided into two groups: Group A (286 patients) (70.4%) did not suffer from any sternal wound complications, where as group B patients (n = 63) (15.6%) needed subsequent surgery due to sternal infection. There were no significant differences in either concerning age, clinical data and first operation. All patients had an average blood loss of 223 ml/hr. The time before re-operation for bleeding was 5.3+/-1.7 hours in group A compared to 11.1+/-4.2 hours in group B (p<0.05). A significant delay of reoperation for bleeding could also be found for patients with postoperative septic complications (ø: 5.2+/-1.9 hours, +: 12.9+/-5.2 hours), renal failure, mechanical ventilation >48 hours and a stay in hospital >20 days.
Early reoperation for postoperative bleeding decreases the number of subsequent complications, e.g. sternal wound infections, septic complications and prolonged mechanical ventilation.
既往关于胸骨伤口感染的研究表明，糖尿病、肥胖、使用双侧乳内动脉移植物、肾功能受损及再次手术等为易感因素。我们想要评估术后出血行再次胸骨切开术的时间是否会对胸骨伤口感染及其他并发症的发生有任何影响。
1987年至1998年间，在我们科室，12315例患者接受了心脏手术的正中胸骨切开术。我们分析了所有因术后出血而接受再次手术患者的临床资料，尤其是因胸骨伤口感染导致后续手术的患者。所有数据分别采用t检验和卡方检验进行比较，p<0.05被视为具有统计学意义。
12315例患者中有406例因术后出血接受再次探查（3.3%）。其中57例（14%）患者在术后因非感染性并发症死亡。其余患者分为两组：A组（286例患者）（70.4%）未发生任何胸骨伤口并发症，而B组患者（n = 63）（15.6%）因胸骨感染需要后续手术。在年龄、临床资料及首次手术方面，两组均无显著差异。所有患者平均失血速度为223 ml/小时。A组出血后再次手术的时间为5.3±1.7小时，而B组为11.1±4.2小时（p<0.05）。对于术后发生感染性并发症（平均：5.2±1.9小时，范围：12.9±5.2小时）、肾衰竭、机械通气>48小时及住院>20天的患者，也可发现出血后再次手术存在显著延迟。
术后出血早期再次手术可减少后续并发症的数量，如胸骨伤口感染、感染性并发症及机械通气时间延长。
