Haughey Niamh, Booth Karen, Parissis Haralabos
Department of Cardiac Surgery, Royal Victoria Hospital, Belfast, UK.
Department of Cardiac Surgery, Royal Victoria Hospital, Belfast, UK
Asian Cardiovasc Thorac Ann. 2016 Jul;24(6):530-4. doi: 10.1177/0218492316655033. Epub 2016 Jun 7.
Post-cardiotomy open chest management is used either for salvage or as a planned therapeutic option in patients with low cardiac output, hemorrhage, or intractable arrhythmias. We reviewed our experience with these patients.
Over a 3-year period, 2534 adult cardiac patients were operated on and 35 (1.4%) had delayed sternal closure. The median age was 72 years (range 46-86 years) and mean logistic EuroSCORE I was 11.29 (range 1.33-84.99). The patients were divided into two groups: group A (22/35, 62.9%) left the operating room without sternal closure due to hemodynamic instability after coming off cardiopulmonary bypass; group B (13/35, 37.1%) had a resternotomy and sternal closure was delayed due to acute deterioration in the cardiac intensive care unit.
The median intensive care unit stay was 17 days (range 2-70 days). Mortality was 25.7% (9 patients). All survivors were followed-up for at least 2 years, with a 2-year survival rate of 57.1%. Overall mortality was broadly similar in both groups. There was a high rate of postoperative complications in both groups, including chest sepsis (77%), liver failure (14.3), renal failure requiring renal replacement therapy (42.9%), sternal wound infection (28.6%), gut ischemia (2.9%), cerebrovascular accident (11.4), and multiorgan failure (31.4%).
Some may argue that open chest management is an acceptable salvage procedure, however, follow-up demonstrated significant adverse cardiac or cerebrovascular events in a short period following discharge, thus delayed sternal closure is really a salvage procedure but useful in centers without access to extracorporeal membrane oxygenation.
心脏手术后的开胸处理用于抢救，或作为心输出量低、出血或顽固性心律失常患者的一种计划性治疗选择。我们回顾了我们对这些患者的治疗经验。
在3年期间，2534例成年心脏患者接受了手术，35例（1.4%）延迟胸骨闭合。中位年龄为72岁（范围46 - 86岁），平均逻辑欧洲心脏手术风险评估系统I评分为11.29（范围1.33 - 84.99）。患者分为两组：A组（22/35，62.9%）在脱离体外循环后因血流动力学不稳定未进行胸骨闭合而离开手术室；B组（13/35，37.1%）进行了再次开胸手术，因心脏重症监护病房的急性病情恶化而延迟胸骨闭合。
重症监护病房的中位住院时间为17天（范围2 - 70天）。死亡率为25.7%（9例患者）。所有幸存者均随访至少2年，2年生存率为57.1%。两组的总体死亡率大致相似。两组术后并发症发生率都很高，包括胸部感染（77%）、肝功能衰竭（14.3%）、需要肾脏替代治疗的肾功能衰竭（42.9%）、胸骨伤口感染（28.6%）、肠道缺血（2.9%）、脑血管意外（11.4%）和多器官功能衰竭（31.4%）。
有些人可能认为开胸处理是一种可接受的抢救措施，然而，随访显示出院后短期内出现了显著的不良心脏或脑血管事件，因此延迟胸骨闭合实际上是一种抢救措施，但在无法进行体外膜肺氧合的中心是有用的。
