[延迟胸骨闭合的心脏手术患儿手术部位感染：病例对照研究]
[Surgical site infections in children undergoing cardiac surgery with delayed sternal closure: Case-control study].
作者信息
Retamal Javiera, Becker Pedro, González Rodrigo, Ferrés Marcela, Cerda Jaime, Riquelme María I, Pérez Regina, Clavería Cristián
机构信息
División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile,
División de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
出版信息
Rev Chilena Infectol. 2016 Oct;33(5):495-500. doi: 10.4067/S0716-10182016000500001.
INTRODUCTION
Surgical site infections (SSI) are an important cause of morbidity in pediatric cardiac surgery. Risk factors in patients requiring delayed sternal closure (DSC) are unknown.
AIM
To report the rate of SSI in children undergoing cardiac surgery with DSC and determine the risk factors.
METHODOLOGY
A retrospective case-control study, in patients younger than 15 years old undergoing cardiac surgery with DSC in our center between 2009 and 2010. SSI was diagnosed according to the criteria of the nosocomial infections committee of our institution, based on international recommendations. Univariate and multivariate analysis of variables was performed. A p < 0.05 was considered significant.
RESULTS
58 patients were included; the average age was 9.5 days. The most frequent diagnosis were transposition of the great arteries (36%) and hypoplastic left heart syndrome (27%). 13 patients had SSI (22%); 11 incisional and 2 mediastinitis. It was independently associated to SSI by-pass (BP) time longer than 200 min (OR adjusted = 9,53; IC 95% 1,37-66,35) and mechanical ventilation (MV) more than 5 days (OR adjusted = 8,98; IC 95% 1,16-69,40).
CONCLUSION
The duration of BP and MV are risk factors of SSI in children undergoing cardiac surgery with DSC.
引言
手术部位感染（SSI）是小儿心脏手术中发病的重要原因。需要延迟胸骨闭合（DSC）的患者的危险因素尚不清楚。
目的
报告接受DSC心脏手术的儿童的SSI发生率并确定危险因素。
方法
一项回顾性病例对照研究，研究对象为2009年至2010年在我们中心接受DSC心脏手术的15岁以下患者。根据我们机构医院感染委员会的标准，基于国际建议诊断SSI。对变量进行单因素和多因素分析。p<0.05被认为具有统计学意义。
结果
纳入58例患者；平均年龄为9.5天。最常见的诊断是大动脉转位（36%）和左心发育不全综合征（27%）。13例患者发生SSI（22%）；11例为切口感染，2例为纵隔炎。与SSI独立相关的因素是体外循环（BP）时间超过200分钟（调整后的OR=9.53；95%可信区间1.37-66.35）和机械通气（MV）超过5天（调整后的OR=8.98；95%可信区间1.16-69.40）。
结论
BP和MV的持续时间是接受DSC心脏手术的儿童发生SSI的危险因素。
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