心脏与胸骨之间的坚固屏障可防止在负压伤口治疗期间心脏和肺部破裂。

A rigid barrier between the heart and sternum protects the heart and lungs against rupture during negative pressure wound therapy.

作者信息

Lindstedt Sandra, Ingemansson Richard, Malmsjö Malin

机构信息

Department of Cardiothoracic Surgery, Lund University and Skåne University Hospital, Lund, Sweden.

出版信息

J Cardiothorac Surg. 2011 Jul 8;6:90. doi: 10.1186/1749-8090-6-90.

DOI:10.1186/1749-8090-6-90

PMID:21740574

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3142210/

Abstract

OBJECTIVES

Right ventricular heart rupture is a devastating complication associated with negative pressure wound therapy (NPWT) in cardiac surgery. The use of a rigid barrier has been suggested to offer protection against this lethal complication, by preventing the heart from being drawn up and damaged by the sharp edges of the sternum. The aim of the present study was to investigate whether a rigid barrier protects the heart and lungs against injury during NPWT.

METHODS

Sixteen pigs underwent median sternotomy followed by NPWT at -120 mmHg for 24 hours, in the absence (eight pigs) or presence (eight pigs) of a rigid plastic disc between the heart and the sternal edges. The macroscopic appearance of the heart and lungs was inspected after 12 and 24 hours of NPWT.

RESULTS

After 24 hours of NPWT at -120 mmHg the area of epicardial petechial bleeding was 11.90 ± 1.10 cm² when no protective disc was used, and 1.15 ± 0.19 cm² when using the disc (p < 0.001). Heart rupture was observed in three of the eight animals treated with NPWT without the disc. Lung rupture was observed in two of the animals, and lung contusion and emphysema were seen in all animals treated with NPWT without the rigid disc. No injury to the heart or lungs was observed in the group of animals treated with NPWT using the rigid disc.

CONCLUSION

Inserting a rigid barrier between the heart and the sternum edges offers protection against heart rupture and lung injury during NPWT.

摘要

目的

右心室心脏破裂是心脏手术中与负压伤口治疗（NPWT）相关的一种毁灭性并发症。有人建议使用刚性屏障，通过防止心脏被胸骨边缘拉起并受损，来预防这种致命并发症。本研究的目的是调查刚性屏障在NPWT期间是否能保护心脏和肺部免受损伤。

方法

16头猪接受正中胸骨切开术，然后在-120 mmHg下进行NPWT 24小时，其中8头猪在心脏与胸骨边缘之间不存在刚性塑料盘（对照组），另外8头猪存在刚性塑料盘（实验组）。在NPWT 12小时和24小时后检查心脏和肺部的宏观外观。

结果

在-120 mmHg下进行24小时NPWT后，未使用保护盘时，心外膜瘀点出血面积为11.90±1.10 cm²，使用保护盘时为1.15±0.19 cm²（p<0.001）。在未使用盘进行NPWT治疗的8只动物中，有3只观察到心脏破裂。在2只动物中观察到肺破裂，在未使用刚性盘进行NPWT治疗的所有动物中均观察到肺挫伤和肺气肿。在使用刚性盘进行NPWT治疗的动物组中，未观察到心脏或肺部损伤。