Schimmer C, Sommer S P, Bensch M, Elert O, Leyh R
Department of Heart Surgery, University Hospital Würzburg, Würzburg, Germany.
Thorac Cardiovasc Surg. 2008 Jun;56(4):200-4. doi: 10.1055/s-2008-1038386.
Different primary treatment modalities have been utilized to treat poststernotomy mediastinitis (PM) following cardiac surgery.
A literature survey using the key phrases "treatment of deep sternal wound infection" and "poststernotomy-mediastinitis" was performed. Furthermore, a questionnaire regarding the primary treatment of PM was distributed to all 79 German heart surgery centers.
The review of the literature shows that the current understanding is based purely on retrospective studies, not on evidence-based medicine. All 79 German heart centers replied to the questionnaire. Vacuum-assisted closure therapy (V. A. C.(R)) is used in 28/79 (35 %) heart centers as the "first-line" treatment, 22/79 (28 %) perform primary reclosure in conjunction with a double-tube irrigation/suction system, and in 29/79 (37 %) German heart centers both treatment options were used according to the intraoperative conditions.
As a primary treatment for PM two treatment modalities are currently in use: primary reclosure coupled with a double-tube suction/irrigation system versus V. A. C.(R) therapy. Since prospective randomized studies have not yet been performed, controlled clinical trials comparing both treatment modalities are pivotal to define the evidence for patients presenting with PM.
心脏手术后，已采用不同的主要治疗方式来治疗胸骨切开术后纵隔炎（PM）。
使用关键词组“深部胸骨伤口感染的治疗”和“胸骨切开术后纵隔炎”进行文献检索。此外，还向所有79家德国心脏外科中心发放了一份关于PM主要治疗方法的调查问卷。
文献综述表明，目前的认识纯粹基于回顾性研究，而非循证医学。所有79家德国心脏中心都回复了调查问卷。28/79（35%）的心脏中心将负压封闭引流疗法（V.A.C.®）用作“一线”治疗方法，22/79（28%）的中心采用联合双管冲洗/吸引系统进行一期缝合，29/79（37%）的德国心脏中心根据术中情况同时使用这两种治疗方法。
目前作为PM的主要治疗方法有两种：联合双管吸引/冲洗系统的一期缝合与V.A.C.®疗法。由于尚未进行前瞻性随机研究，比较这两种治疗方法的对照临床试验对于确定PM患者的治疗依据至关重要。
