Peigh Graham, Kumar Jeevan, Unai Shinya, James Diehl T, Hirose Hitoshi
Division of Cardiothoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Heart Surg Forum. 2017 Aug 28;20(4):E164-E169. doi: 10.1532/hsf.1860.
A previous retrospective analysis of our cardiac surgery patients showed shortened ventilation time and hospital stay among patients receiving rigid sternal fixation compared to sternal wire fixation. We performed a prospective randomized study to further investigate these outcomes and determine if rigid closure can provide reduced pain after cardiac surgery.
Patients undergoing cardiac surgery between July 2011 and May 2014 were prospectively randomized into wire closure (Group C) or rigid fixation using sternal plates (Group R) groups. Age above 80, emergency surgery, redo sternotomy, and immunosuppression were among major exclusion criteria precluding randomization. Intubation time was recorded for all patients. Pain scores were determined daily from postoperative day 1 until day 5 at 6 a.m. using a numeric rating scale. Narcotic pain medication requirements from day 1 to 5 were collected and converted into intravenous morphine equivalents.
Of 80 patients, 39 patients were in Group R (average age 65 ± 8; 31 male and 8 female) and 41 patients were in Group C (average age 66 ± 9; 34 male and 7 female). Group R patients had a higher body mass index than patients in Group C (Group R: 31 ± 5; Group C: 29 ± 5; P = .04). No significant differences in the end points of intubation time and postoperative pain were observed. Conclusion: This randomized study of cardiac surgery patients showed no significant benefits of rigid fixation over conventional sternal wire closure with regard to intubation time, postoperative pain, or length of hospital stay.
我们之前对心脏手术患者的回顾性分析显示，与胸骨钢丝固定相比，接受刚性胸骨固定的患者通气时间缩短，住院时间缩短。我们进行了一项前瞻性随机研究，以进一步调查这些结果，并确定刚性闭合是否能减轻心脏手术后的疼痛。
2011年7月至2014年5月接受心脏手术的患者被前瞻性随机分为钢丝闭合组（C组）或使用胸骨板的刚性固定组（R组）。年龄超过80岁、急诊手术、再次胸骨切开术和免疫抑制是排除随机分组的主要标准。记录所有患者的插管时间。从术后第1天到第5天每天上午6点使用数字评分量表确定疼痛评分。收集第1天到第5天的麻醉性止痛药物需求量，并换算成静脉注射吗啡当量。
80例患者中，R组39例（平均年龄65±8岁；男31例，女8例），C组41例（平均年龄66±9岁；男34例，女7例）。R组患者的体重指数高于C组患者（R组：31±5；C组：29±5；P = 0.04）。在插管时间和术后疼痛终点方面未观察到显著差异。结论：这项对心脏手术患者的随机研究表明，在插管时间、术后疼痛或住院时间方面，刚性固定相对于传统的胸骨钢丝闭合没有显著益处。
