Department of Cardiovascular Surgery, Omura Municipal Hospital, Cardiovascular Center, Nagasaki, Japan.
Surg Today. 2009;39(10):848-54. doi: 10.1007/s00595-008-3974-5. Epub 2009 Sep 27.
This prospective and semi-randomized study was conducted to clarify the effectiveness of a new hydrocolloid dressing placed over median sternotomy wounds using an occlusive dressing technique.
The subjects were 253 patients undergoing coronary artery bypass grafting (CABG), who were randomized to receive either the new hydrocolloid dressing (Karayahesive, n = 117) or a polyurethane foam dressing (Tegaderm plus Pad, n = 136) immediately after sternal wound closure. Karayahesive was left in place for 7 days, whereas the Tegaderm plus Pad was removed on postoperative day (POD) 2 and replaced with an adhesive wound dressing until POD 7.
In the Karayahesive group, complete integrity of the wound was achieved in 91% of the patients, with an infection developing in 3.4%: as a superficial surgical site infection (SSI) in three and as a deep SSI in one. On the other hand, in the Tegaderm plus Pad group, an infection developed in 10.3% (14 patients) of the patients: as a superficial SSI in nine and as a deep SSI in five (P < 0.05). The total treatment costs from the application of the dressing until completion of treatment was 699 yen for the Karayahesive and 910 yen for the Tegaderm plus Pad (P < 0.001).
The new hydrocolloid dressing, applied with an occlusive dressing technique to median sternotomy wounds, prevented SSI and was cost effective.
本前瞻性半随机研究旨在阐明一种新的水胶体敷贴,在使用密闭敷贴技术覆盖正中胸骨切开术后伤口时的有效性。
253 例行冠状动脉旁路移植术(CABG)的患者参与了本研究,在胸骨关闭后,患者被随机分为两组,分别使用新的水胶体敷贴(卡拉胶,n = 117)或聚氨酯泡沫敷贴(Tegaderm plus Pad,n = 136)。卡拉胶敷贴保留 7 天,而 Tegaderm plus Pad 在术后第 2 天(POD)去除,并更换粘性伤口敷贴,直至 POD 7。
在卡拉胶组,91%的患者伤口完全愈合,感染率为 3.4%:3 例为浅表手术部位感染(SSI),1 例为深部 SSI。另一方面,在 Tegaderm plus Pad 组,10.3%(14 例)的患者发生感染:9 例为浅表 SSI,5 例为深部 SSI(P < 0.05)。从使用敷贴到完成治疗的总治疗费用,卡拉胶为 699 日元,Tegaderm plus Pad 为 910 日元(P < 0.001)。
新的水胶体敷贴,使用密闭敷贴技术应用于正中胸骨切开术伤口,可以预防 SSI 并具有成本效益。