Vos Roemer J, van Putte Bart P, Sonker Uday, Kloppenburg Geoffrey T L
Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands.
Interact Cardiovasc Thorac Surg. 2014 Jan;18(1):33-7. doi: 10.1093/icvts/ivt385. Epub 2013 Sep 26.
Post-sternotomy mediastinitis is a severe complication of open heart surgery resulting in prolonged hospital stay and increased mortality. Vacuum-assisted closure is commonly used as treatment for post-sternotomy mediastinitis, but has some disadvantages. Primary closure over high vacuum suction Redon drains previously has shown to be an alternative approach with promising results. We report our short- and long-term results of Redon therapy-treated mediastinitis.
We performed a retrospective analysis of 124 patients who underwent primary closure of the sternum over Redon drains as treatment for post-sternotomy mediastinitis in Amphia Hospital (Breda, Netherlands) and St. Antonius Hospital (Nieuwegein, Netherlands). Patient characteristics, preoperative risk factors and procedure-related variables were analysed. Duration of therapy, hospital stay, treatment failure and mortality as well as C-reactive protein and blood leucocyte counts on admission and at various time intervals during hospital stay were determined.
Mean age of patients was 68.7 ± 11.0 years. In 77.4%, the primary surgery was coronary artery bypass grafting. Presentation of mediastinitis was 15.2 ± 9.8 days after surgery. Duration of Redon therapy was 25.9 ± 18.4 days. Hospital stay was 32.8 ± 20.7 days. Treatment failure occurred in 8.1% of patients. In-hospital mortality was 8.9%. No risk factors were found for mortality or treatment failure. The median follow-up time was 6.6 years. One- and 5-year survivals were 86 and 70%, respectively.
Primary closure using Redon drains is a feasible, simple and efficient treatment modality for post-sternotomy mediastinitis.
胸骨切开术后纵隔炎是心脏直视手术的一种严重并发症，会导致住院时间延长和死亡率增加。负压封闭引流常用于胸骨切开术后纵隔炎的治疗，但存在一些缺点。此前，在高负压吸引的雷顿引流管上进行一期缝合已被证明是一种有前景的替代方法。我们报告了雷顿疗法治疗纵隔炎的短期和长期结果。
我们对124例在荷兰布雷达的安菲亚医院和荷兰新韦根的圣安东尼医院接受雷顿引流管胸骨一期缝合治疗胸骨切开术后纵隔炎的患者进行了回顾性分析。分析了患者特征、术前危险因素和与手术相关的变量。确定了治疗持续时间、住院时间、治疗失败率和死亡率，以及入院时和住院期间不同时间间隔的C反应蛋白和血白细胞计数。
患者的平均年龄为68.7±11.0岁。77.4%的患者初次手术为冠状动脉旁路移植术。纵隔炎出现在术后15.2±9.8天。雷顿疗法的持续时间为25.9±18.4天。住院时间为32.8±20.7天。8.1%的患者治疗失败。住院死亡率为8.9%。未发现死亡率或治疗失败的危险因素。中位随访时间为6.6年。1年和5年生存率分别为86%和70%。
使用雷顿引流管进行一期缝合是治疗胸骨切开术后纵隔炎的一种可行、简单且有效的治疗方式。
