Bryan A J, Lamarra M, Angelini G D, West R R, Breckenridge I M
Department of Cardiac Surgery, University Hospital of Wales, Cardiff, UK.
J R Coll Surg Edinb. 1992 Oct;37(5):305-8.
Over a 5-year period from 1985 to 1989, 2760 patients underwent open heart surgery at the University Hospital of Wales. Of these, 44 (1.6%, 35 men, mean age 61 years) developed median sternotomy dehiscence 2-40 (median 9) days after surgery. Infection was an associated factor in 18 patients (41%) and Staphylococcus aureus the predominant isolate in seven of those. Thirty-seven patients underwent rewiring of the sternotomy wound and seven patients underwent debridement, removal of wires and delayed closure. In those undergoing rewiring, sternal stability was maintained in 34 patients (92%). There were seven deaths (16%), of which two were considered to be wound-related. Median hospital stay of survivors was 34 (range 16-84) days. Comparison with 88 matched controls by univariate analysis showed preoperative chronic obstructive airways disease, reduced FEV1/FVC ratio (both P < 0.001) and smoking (P < 0.05) were all more common in the dehiscence group. In addition, reoperation for bleeding (P < 0.05), prolonged bypass time, postoperative ventilation period and length of stay in the intensive care unit (all P < 0.001) were more common in the study group.
在1985年至1989年的5年期间，2760例患者在威尔士大学医院接受了心脏直视手术。其中，44例（1.6%，35名男性，平均年龄61岁）在术后2至40天（中位数9天）出现了正中胸骨切开术伤口裂开。18例患者（41%）存在感染相关因素，其中7例主要分离出金黄色葡萄球菌。37例患者进行了胸骨切开术伤口重新缝合，7例患者进行了清创、取出钢丝并延迟缝合。在接受重新缝合的患者中，34例（92%）维持了胸骨稳定性。有7例死亡（16%），其中2例被认为与伤口有关。幸存者的中位住院时间为34天（范围16 - 84天）。通过单因素分析与88例匹配对照进行比较，结果显示术前慢性阻塞性气道疾病、FEV1/FVC比值降低（均P < 0.001）和吸烟（P < 0.05）在伤口裂开组中更为常见。此外，因出血再次手术（P < 0.05）、体外循环时间延长、术后通气时间以及在重症监护病房的住院时间（均P < 0.001）在研究组中更为常见。
