Patel Amit N, Selzman Craig H, Kumpati Ganesh S, McKellar Stephen H, Bull David A
Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA.
J Cardiothorac Surg. 2016 Apr 12;11(1):62. doi: 10.1186/s13019-016-0452-9.
Deep and superficial sternal wound infections (DSWI & SWI) following cardiac surgery increase morbidity, mortality and cost. Autologous platelet rich plasma (PRP) derived from the patient's own blood has been used in other surgical settings to promote successful wound healing. The goal of this study was to analyze the addition of PRP using a rapid point of care bedside system to standard wound care in all patients undergoing sternotomy for cardiac surgical procedures.
Over a 7 year period, 2000 patients undergoing open cardiac operations requiring sternotomy were enrolled. One thousand patients received standard of care sternal closure. The other 1000 patients received standard of care sternal closure plus PRP applied to the sternum at the time of closure. The outcomes related to wound healing, infection, readmissions, and costs were analyzed.
In the 2000 patients, there were more ventricular assist device implants/heart transplants and emergency operations in the PRP group; otherwise there were no significant differences. The use of PRP reduced the incidence of DSWI from 2.0 to 0.6 %, SWI from 8.0 to 2.0 %, and the readmission rate from 4.0 to 0.8 %. The use of PRP reduced the costs associated with the development of deep and superficial wound complications from $1,256,960 to $593,791.
The use of PRP decreases the incidence and costs of sternal wound complications following cardiac surgery. The routine use of platelet rich plasma should be considered for all patients undergoing sternotomy for cardiac surgical procedures.
Clinicaltrials.gov ( NCT00130377 ) for the data registry.
心脏手术后的深部和表浅胸骨伤口感染（DSWI和SWI）会增加发病率、死亡率和成本。源自患者自身血液的自体富血小板血浆（PRP）已在其他手术中用于促进伤口顺利愈合。本研究的目的是分析在所有接受心脏手术胸骨切开术的患者中，使用快速床旁即时检测系统将PRP添加到标准伤口护理中的效果。
在7年期间，纳入了2000例需要进行胸骨切开术的心脏直视手术患者。1000例患者接受标准的胸骨闭合护理。另外1000例患者接受标准的胸骨闭合护理，并在闭合时将PRP应用于胸骨。分析与伤口愈合、感染、再入院和成本相关的结果。
在这2000例患者中，PRP组的心室辅助装置植入/心脏移植和急诊手术更多；除此之外没有显著差异。PRP的使用使DSWI的发生率从2.0%降至0.6%，SWI从8.0%降至2.0%，再入院率从4.0%降至0.8%。PRP的使用使与深部和表浅伤口并发症发生相关的成本从1256960美元降至593791美元。
PRP的使用降低了心脏手术后胸骨伤口并发症的发生率和成本。对于所有接受心脏手术胸骨切开术的患者，应考虑常规使用富血小板血浆。
数据注册在Clinicaltrials.gov（NCT00130377）。
