Deutsches Herzzentrum Berlin, Berlin, Germany.
J Thorac Cardiovasc Surg. 2010 Nov;140(5):1133-6. doi: 10.1016/j.jtcvs.2010.06.063. Epub 2010 Sep 15.
Negative pressure wound therapy is the first-line treatment modality for poststernotomy mediastinitis in many heart centers. The aim of this study was to analyze major complications and possible preventive methods during negative pressure wound therapy in patients with deep sternal wound infections.
We retrospectively analyzed 69 consecutive patients treated with negative pressure wound therapy for poststernotomy mediastinitis between June 2006 and September 2009.
Five (7.2%) patients sustained major complications during negative pressure wound therapy. Bleeding from coronary artery venous bypass grafts was observed in 4 patients and fulminant bleeding from an infected homograft of the ascending aorta was observed in 1 patient during routine dressing changes of the negative pressure wound therapy system.
Bleeding is the major complication during negative pressure wound therapy for poststernotomy mediastinitis. Covering the heart with several layers of paraffin gauze is a necessary protective maneuver but cannot completely prevent major complications during negative pressure wound therapy. All operative procedures, including dressing changes, should be performed in the operating room under optimal hygienic and monitoring conditions to increase the salvage rate and to guarantee optimal surgical and anesthesiologic conditions in case of negative pressure wound therapy-related complications.
负压伤口治疗是许多心脏中心治疗胸骨后感染的一线治疗方式。本研究旨在分析胸骨切开术后感染患者接受负压伤口治疗期间的主要并发症及可能的预防方法。
我们回顾性分析了 2006 年 6 月至 2009 年 9 月期间 69 例因胸骨后感染而接受负压伤口治疗的连续患者。
5（7.2%）例患者在负压伤口治疗期间发生主要并发症。在负压伤口治疗系统的常规换药过程中，4 例患者的冠状动脉静脉旁路移植血管出血，1 例患者感染性升主动脉同种移植物发生暴发性出血。
出血是胸骨切开术后感染患者接受负压伤口治疗的主要并发症。用数层石蜡纱布覆盖心脏是必要的保护措施，但不能完全防止负压伤口治疗期间的主要并发症。所有手术操作，包括换药，均应在手术室中进行，以在发生与负压伤口治疗相关的并发症时提高成活率，并保证最佳的手术和麻醉条件。
