Madsboell Thyge K, Vestergaard Rikke F, Andelius Ted C, Hauge Ellen M, Hasenkam J Michael
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus N, Denmark.
Eur J Cardiothorac Surg. 2014 Mar;45(3):476-80. doi: 10.1093/ejcts/ezt410. Epub 2013 Aug 7.
One of the most frequent complications in cardiac surgery is postoperative bleeding from the sternum. To diminish the risk of bleeding, bone wax is frequently used for haemostasis. However, we have previously shown that bone wax impairs bone healing and induces inflammation in the sternum. A new, water-soluble polymer wax enriched with gentamicin has haemostatic properties similar to bone wax and may diminish the risk of infection. The purpose of this study was to determine whether the gentamicin-enriched, water-soluble polymer wax could reduce infection rates when compared with bone wax in a porcine model.
Thirty-two Landrace/Yorkshire pigs were sternotomized and randomized to haemostasis by gentamicin-enriched, water-soluble polymer wax (Gen group) or bone wax (Wax group). After 4 weeks the pigs were euthanized. Blood samples were analysed for the fraction and concentration of neutrophil granulocytes and C-reactive protein and the surgical site was biopsied. Stereology was performed on histological samples, and the magnitude of infection was quantified as the areas of microabscesses, granulomas and tissue with acute inflammation compared with the total tissue area.
The temperature was 38.2 °C in the Gen group vs 38.6 °C in the Wax group, P < 0.05. No animals in the Gen group and three in the Wax group showed a temperature >39.3 °C. Neutrophil granulocyte concentration was 5.00 × 10(9)/l in the Gen group and 6.92 × 10(9)/l in the Wax group, P = 0.277, with a leucocyte fraction of 20.9% vs 29.3%, P = 0.119. C-reactive protein (CRP) was 142 mg/l in the Gen group compared with 318 mg/l in the Wax group, P = 0.106. Histological samples showed acute inflammatory changes in 5.0% of the tissue in the Gen group vs 18.3% in the Wax group, P < 0.001. Microabscesses were present in 0.3% of the sample tissue in the Gen group vs 2.2% in the Wax group, P < 0.001. Concentrations of gentamicin were >100 mg/l in mediastinal fluid and <2 mg/l in venous blood.
When used for haemostasis after sternotomy in a porcine model, gentamicin-enriched, water-soluble polymer wax reduces sign of infection when compared with bone wax and therefore appears to be a more suitable choice for preventing postoperative, sternal osteomyelitis.
心脏手术中最常见的并发症之一是胸骨术后出血。为降低出血风险，骨蜡常被用于止血。然而，我们之前已表明骨蜡会损害骨愈合并诱发胸骨炎症。一种富含庆大霉素的新型水溶性聚合物蜡具有与骨蜡相似的止血特性，且可能降低感染风险。本研究的目的是在猪模型中确定与骨蜡相比，富含庆大霉素的水溶性聚合物蜡是否能降低感染率。
将32只长白/约克夏猪进行胸骨切开术，并随机分为用富含庆大霉素的水溶性聚合物蜡止血组（Gen组）和骨蜡止血组（Wax组）。4周后对猪实施安乐死。分析血样中的中性粒细胞分数和浓度以及C反应蛋白，并对手术部位进行活检。对组织学样本进行体视学分析，将感染程度量化为微脓肿、肉芽肿和急性炎症组织的面积与总组织面积的比值。
Gen组体温为38.2℃，Wax组为38.6℃，P<0.05。Gen组无动物体温>39.3℃，Wax组有3只动物体温>39.3℃。Gen组中性粒细胞浓度为5.00×10⁹/L，Wax组为6.92×10⁹/L，P = 0.277，白细胞分数分别为20.9%和29.3%，P = 0.119。Gen组C反应蛋白（CRP）为142mg/L，Wax组为318mg/L，P = 0.106。组织学样本显示，Gen组5.0%的组织有急性炎症改变，Wax组为18.3%，P<0.001。Gen组0.3%的样本组织有微脓肿，Wax组为2.2%，P<0.001。纵隔液中庆大霉素浓度>100mg/L，静脉血中<2mg/L。
在猪模型中用于胸骨切开术后止血时，与骨蜡相比，富含庆大霉素的水溶性聚合物蜡可降低感染迹象，因此似乎是预防术后胸骨骨髓炎更合适的选择。
