Domkowski Patrick W, Smith Monica L, Gonyon Denis L, Drye Carol, Wooten Mary Kay, Levin L Scott, Wolfe Walter G
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
J Thorac Cardiovasc Surg. 2003 Aug;126(2):386-90. doi: 10.1016/s0022-5223(03)00352-0.
Poststernotomy mediastinitis, although infrequent, is a potentially life-threatening complication of cardiac surgery that continues to have a significant morbidity and mortality despite aggressive therapy. Vacuum-assisted closure uses controlled suction to provide evacuation of wound fluid, decrease bacterial colonization, stimulate granulation tissue, and reduce the need for dressing changes.
One hundred two patients from Duke University Hospital, The Durham Veterans Administration Hospital, and referring institutions underwent vacuum-assisted closure treatment. There were 63 men and 39 women, with a mean age of 67. The infection was noticed between postoperative days 8 and 34, at which time the wounds were opened and debrided.
Ninety-six of the 102 patients received vacuum-assisted therapy while the remaining 6 underwent daily multiple dressing changes without vacuum-assisted therapy. Fifty-three of the 96 patients required only sternal debridement, followed by wound vacuum therapy and closure by secondary intention, while the remaining 43 had an additional procedure. Of these, 33 patients underwent omental transposition and 10 patients had a pectoralis flap. The length of stay for all patients was 27 +/- 12 days. This was related in part to intravenous antibiotics. Hospital mortality for all patients was 3.7% (4 patients). Two of these patients underwent vascular flap and succumbed to multisystemic organ failure, while the other 2 received only wound vacuum therapy following debridement and succumbed to overwhelming sepsis.
Vacuum-assisted drainage is an effective therapy for mediastinitis following debridement or before placement of a vascularized tissue flap.
胸骨切开术后纵隔炎虽不常见，但却是心脏手术潜在的危及生命的并发症，尽管采取积极治疗，其发病率和死亡率仍居高不下。负压封闭引流利用可控性吸引来排出伤口液体、减少细菌定植、刺激肉芽组织生长并减少换药需求。
来自杜克大学医院、达勒姆退伍军人管理局医院及转诊机构的102例患者接受了负压封闭引流治疗。其中男性63例，女性39例，平均年龄67岁。感染在术后第8天至第34天被发现，此时伤口开放并进行清创。
102例患者中有96例接受了负压辅助治疗，其余6例未接受负压辅助治疗，而是每天多次换药。96例患者中有53例仅需进行胸骨清创，随后进行伤口负压治疗并通过二期愈合关闭伤口，其余43例还进行了额外的手术。其中，33例患者进行了网膜转移术，10例患者进行了胸大肌皮瓣移植术。所有患者的住院时间为27±12天。这在一定程度上与静脉使用抗生素有关。所有患者的医院死亡率为3.7%（4例）。其中2例患者进行了血管皮瓣移植，死于多系统器官衰竭，另外2例患者在清创后仅接受了伤口负压治疗，死于严重脓毒症。
负压引流是清创后或带血管组织瓣植入前治疗纵隔炎的有效方法。
