Eklund Anne M, Lyytikäinen Outi, Klemets Peter, Huotari Kaisa, Anttila Veli-Jukka, Werkkala Kalervo A, Valtonen Matti
Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland.
Ann Thorac Surg. 2006 Nov;82(5):1784-9. doi: 10.1016/j.athoracsur.2006.05.097.
Poststernotomy mediastinitis as a complication is rare but disastrous. We assessed incidence, predisposing factors for, and outcome from, mediastinitis after cardiac surgery.
We studied 10,713 consecutive patients who underwent open-heart surgery from 1990 to 1999 in a tertiary care university hospital using data prospectively recorded in the hospital discharge register, operating room log, and the hospital's cardiothoracic surgery unit register. Those cases with possible mediastinitis were identified from the hospital infection register and discharge register. Patients' charts were reviewed and cases of mediastinitis confirmed based on criteria of the Centers for Disease Control and Prevention.
The overall rate of mediastinitis was 1.1% (120 cases), and higher in coronary artery bypass surgery than in valvular surgery (1.2 vs 0.8%). No trend in incidence was detectable, although surgical patients became progressively older (mean age, 59 to 65 years, p < 0.01), and the proportion of women (from 25% to 31%; p < 0.01) and of patients with American Society of Anesthesiologists score over 3 (from 10% to 81%, p < 0.01) both increased. The rate of mediastinitis was almost twice as high in men (1.2% vs 0.7%, p < 0.01). In three body mass index (BMI) categories (<25, 25 to 30, and >30 kg/m2), rates of mediastinitis were 0.5%, 1.0%, and 1.8%. In multivariate analysis adjusted for age, sex, year, operation type, and perfusion time, the only predictor for mediastinitis was BMI.
Mediastinitis is not diminishing. Larger populations at risk, for example proportions of overweight patients, reinforce the importance of surveillance and pose a challenge in focusing preventive measures.
胸骨切开术后纵隔炎作为一种并发症虽罕见但后果严重。我们评估了心脏手术后纵隔炎的发生率、易感因素及预后。
我们研究了1990年至1999年在一家三级护理大学医院连续接受心脏直视手术的10713例患者，使用前瞻性记录在医院出院登记册、手术室日志和医院心胸外科登记册中的数据。从医院感染登记册和出院登记册中识别出可能患有纵隔炎的病例。查阅患者病历，并根据疾病控制与预防中心的标准确诊纵隔炎病例。
纵隔炎的总体发生率为1.1%（120例），冠状动脉搭桥手术中的发生率高于瓣膜手术（1.2%对0.8%）。尽管手术患者年龄逐渐增大（平均年龄从59岁至65岁，p<0.01），女性比例（从25%增至31%；p<0.01）以及美国麻醉医师协会评分超过3分的患者比例（从10%增至81%，p<0.01）均增加，但未发现发生率有趋势性变化。男性纵隔炎发生率几乎是女性的两倍（1.2%对0.7%，p<0.01）。在三个体重指数（BMI）类别（<25、25至30以及>30kg/m²）中，纵隔炎发生率分别为0.5%、1.0%和1.8%。在对年龄、性别、年份、手术类型和灌注时间进行校正的多因素分析中，纵隔炎的唯一预测因素是BMI。
纵隔炎并未减少。更多的高危人群，例如超重患者的比例增加，强化了监测的重要性，并对针对性预防措施构成挑战。
