Marasco Silvana F, McGiffin David C, Zimmet Adam D, Solis Pablo C, Bingham Judy M, Moshinsky Randall A
From the *Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, Victoria, Australia; †Protego Medical Pty Ltd, Melbourne, Victoria, Australia; ‡Easington Pty Ltd, Camberwell, Victoria, Australia; §Department of Cardiothoracic Surgery, Monash Health, Clayton, Victoria, Australia; and ∥Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
Innovations (Phila). 2017 Sep/Oct;12(5):370-374. doi: 10.1097/IMI.0000000000000409.
Sternal bleeding during cardiac surgery is currently controlled using bone wax or other chemical substances that may result in adverse effects and affect wound healing and recovery. The purpose of this study was to identify a safe, cost-effective, and easy-to-use technique to reduce sternal bleeding and sternal trauma during cardiac surgery.
After sternotomy, a sternal protection device was placed over each hemisternal section before insertion of the retractor and remained in situ until the end of surgery. Sternal bleeding and ease of use were assessed and recorded during surgery. Sternal trauma was assessed and recorded within 5 minutes of removal of the device, and overall satisfaction (Global Impression) and any intraoperative adverse events or device malfunction were reported at surgery completion. Patients were followed up 24 hours and 4 weeks after surgery.
Twelve patients completed the study. Adverse events reported were not considered related to the device. No sternal trauma was identified in any patient. In 9 of 11 patients, sternal bleeding was reduced after insertion of the device. The device was generally considered easy to use, although some difficulty was encountered when used with the Internal Mammary Artery retractor.
Our data suggest that the device is safe and able to reduce sternal bleeding during surgery using sternal retractors. We recommend further studies in a larger population of patients with a control group to evaluate the device's ability to reduce the morbidity associated with sternal bleeding and sternal trauma.
心脏手术期间胸骨出血目前通过骨蜡或其他化学物质控制，这些物质可能会产生不良反应并影响伤口愈合和恢复。本研究的目的是确定一种安全、经济高效且易于使用的技术，以减少心脏手术期间的胸骨出血和胸骨创伤。
胸骨切开术后，在插入牵开器之前，将胸骨保护装置放置在每个半胸骨部分上，并保留在原位直至手术结束。在手术期间评估并记录胸骨出血情况和易用性。在移除装置后5分钟内评估并记录胸骨创伤情况，在手术结束时报告总体满意度（整体印象）以及任何术中不良事件或装置故障。对患者进行术后24小时和4周的随访。
12名患者完成了研究。报告的不良事件被认为与该装置无关。在任何患者中均未发现胸骨创伤。在11名患者中的9名中，装置插入后胸骨出血减少。该装置总体上被认为易于使用，尽管在与胸廓内动脉牵开器一起使用时遇到了一些困难。
我们的数据表明，该装置是安全的，并且能够在使用胸骨牵开器的手术期间减少胸骨出血。我们建议在更大的患者群体中进行进一步研究，并设立对照组，以评估该装置减少与胸骨出血和胸骨创伤相关发病率的能力。
