Sá Michel Pompeu Barros de Oliveira, Soares Evelyn Figueira, Santos Cecília Andrade, Figueiredo Omar Jacobina, Lima Renato Oliveira Albuquerque, Escobar Rodrigo Renda, de Rueda Fábio Gonçalves, Lima Ricardo de Carvalho
Faculdade de Ciências Médicas da Universidade de Pernambuco - FCM/UPE.
Rev Bras Cir Cardiovasc. 2011 Jan-Mar;26(1):27-35. doi: 10.1590/s0102-76382011000100008.
Mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. The aim of this study is to identify risk factors for mediastinitis in patients undergoing coronary artery bypass grafting (CABG), without the use of bilateral internal thoracic artery (ITA), at the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE.
A retrospective study of 500 consecutive patients operated on between May 2007 and April 2010. Ten preoperative variables, seven intraoperative variables and seven postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated. Univariate and multivariate logistic regression analyses were performed.
The incidence of mediastinitis was 5.6% (n=28), with a lethality rate of 32.1% (n=9). In multivariate analysis using logistic regression, five variables remained as independent risk factors: obesity (OR 2.60, 95% CI 1.11 to 6.68), diabetes (OR 2.71, 95% CI 1.18 to 6.65), smoking (OR 2.10, 95% CI 1.12 to 4.67), use of pedicled internal thoracic artery (OR 5.17, 95% CI 1.45 to 18.42) and on-pump CABG (OR 2.26, 95% CI 1.14 to 5.85).
This study identified the following independent risk factors for mediastinitis after CABG: obesity, diabetes, smoking, use of pedicled ITA and on-pump CABG.
纵隔炎是正中开胸手术的严重并发症，与显著的发病率和死亡率相关。本研究的目的是确定在伯南布哥心脏急救中心心血管外科进行冠状动脉旁路移植术（CABG）且未使用双侧胸廓内动脉（ITA）的患者发生纵隔炎的危险因素。
对2007年5月至2010年4月间连续接受手术的500例患者进行回顾性研究。评估了可能与术后纵隔炎发生有关的10个术前变量、7个术中变量和7个术后变量。进行了单因素和多因素逻辑回归分析。
纵隔炎的发生率为5.6%（n = 28），致死率为32.1%（n = 9）。在使用逻辑回归的多因素分析中，有5个变量仍为独立危险因素：肥胖（比值比[OR] 2.60，95%置信区间[CI] 1.11至6.68）、糖尿病（OR 2.71，95% CI 1.18至6.65）、吸烟（OR 2.10，95% CI 1.12至4.67）、使用带蒂胸廓内动脉（OR 5.17，95% CI 1.45至18.42）和体外循环下CABG（OR 2.26，95% CI 1.14至5.85）。
本研究确定了CABG术后纵隔炎的以下独立危险因素：肥胖、糖尿病、吸烟、使用带蒂ITA和体外循环下CABG。
