Kim Dong Jung, Shin Yoon Chul, Kim Dong Jin, Kim Jun Sung, Lim Cheong, Park Kay-Hyun
Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Korea.
J Card Surg. 2016 Nov;31(11):672-676. doi: 10.1111/jocs.12837. Epub 2016 Sep 7.
This study aimed to investigate the efficiency and safety of resternotomy performed in the intensive care unit (ICU) for emergent bleeding control after cardiac surgery when transport of the patient to the operating room (OR) was unsafe or delayed.
Medical records were retrospectively reviewed for 101 patients who underwent resternotomy for bleeding control after cardiac surgery between July 2003 and July 2013. A reoperation was performed in the OR for 61 patients (the OR group) and in the ICU for 40 patients (the ICU group). Perioperative features and outcomes were compared between the two groups.
The ICU group had a higher incidence of cardiopulmonary resuscitation before resternotomy (27.5% vs 3.3%, p < 0.05) and bleeding from the cardiac cannulation or suture sites (46.3% vs 23.3%, p < 0.05). Less time was needed for bleeding control in the ICU group (105.8 ± 40.0 min vs 144.3 ± 50.1 min, p < 0.05). There was no difference in 24-hour chest tube drainage, amount of red blood cell transfusion, need of second resternotomy, ICU and hospital stays, incidence of mediastinal infection (ICU 2.5% vs OR 4.9%, p = 0.542), superficial wound complications (ICU 12.5% vs OR 4.9%, p = 0.168), and in-hospital mortality rate (ICU 22.5% vs OR 13.1%, p = 0.218). Three deaths resulted from cardiac arrest, which occurred during the wait or transportation to the OR for a resternotomy in the OR group.
Resternotomy in the ICU was feasible and allows for more efficient management of bleeding-related instabilities without increasing the risk of infectious complications.
本研究旨在探讨当患者转运至手术室（OR）不安全或延迟时，在重症监护病房（ICU）进行胸骨再切开术以控制心脏手术后紧急出血的有效性和安全性。
回顾性分析2003年7月至2013年7月期间101例因心脏手术后出血而行胸骨再切开术患者的病历。61例患者在手术室进行再次手术（手术室组），40例患者在重症监护病房进行再次手术（重症监护病房组）。比较两组的围手术期特征和结果。
重症监护病房组在胸骨再切开术前心肺复苏的发生率较高（27.5%对3.3%，p<0.05），且心脏插管或缝合部位出血的发生率较高（46.3%对23.3%，p<0.05）。重症监护病房组控制出血所需时间较短（105.8±40.0分钟对144.3±50.1分钟，p<0.05）。两组在24小时胸腔引流管引流量、红细胞输注量、二次胸骨再切开术的需求、重症监护病房和住院时间、纵隔感染发生率（重症监护病房2.5%对手术室4.9%，p = 0.542）、浅表伤口并发症发生率（重症监护病房12.5%对手术室4.9%，p = 0.168）以及院内死亡率（重症监护病房22.5%对手术室13.1%，p = 0.218）方面无差异。3例死亡是由于心脏骤停，发生在手术室组等待或转运至手术室进行胸骨再切开术期间。
在重症监护病房进行胸骨再切开术是可行的，并且能够更有效地处理与出血相关的不稳定情况，而不会增加感染并发症的风险。
