美国胸外科医师协会（AATS）胸骨伤口感染预防与管理指南综述。
A review of the AATS guidelines for the prevention and management of sternal wound infections.
作者信息
Lazar Harold L
机构信息
Division of Cardiac Surgery, The Boston University School of Medicine, 80 East Concord Street, Boston, MA 02118 USA.
出版信息
Indian J Thorac Cardiovasc Surg. 2018 Dec;34(Suppl 3):349-354. doi: 10.1007/s12055-018-0686-3. Epub 2018 Jul 17.
PURPOSE
To summarize the AATS guidelines for the prevention and treatment of sternal wound infections.
METHODS
The current AATS guidelines for the prevention of sternal wound infections during the preoperative, intraoperative, and postoperative periods, and the most effective methods and techniques to treat sternal wound infections were reviewed.
RESULTS
The guidelines identified multiple interventions that can be instituted during the preoperative, intraoperative, and postoperative periods to reduce sternal wound infections during cardiac surgery. These include the use of perioperative antibiotics, glycemic control to maintain serum glucose < 180 mg/dl, avoidance of bone wax and the use of vancomycin paste to the sternal edges, and figure of eight suture techniques to re-approximate the sternum. Wound Vac therapy should be instituted whenever possible to treat and enhance recovery from mediastinitis.
CONCLUSIONS
The prevention of sternal wound infections and mediastinitis can be achieved by adherence to the AATS guidelines. The institution of these interventions requires a multi-disciplinary team effort among surgeons, anesthesiologists, referring physicians, nurses, and OR and ICU personnel.
目的
总结美国胸外科医师协会（AATS）关于胸骨伤口感染预防与治疗的指南。
方法
回顾了AATS目前关于术前、术中和术后预防胸骨伤口感染的指南，以及治疗胸骨伤口感染的最有效方法和技术。
结果
该指南确定了在术前、术中和术后可采取的多种干预措施，以减少心脏手术期间的胸骨伤口感染。这些措施包括围手术期使用抗生素、控制血糖使血清葡萄糖维持在<180 mg/dl、避免使用骨蜡并在胸骨边缘使用万古霉素糊剂，以及采用8字缝合技术重新对合胸骨。应尽可能采用伤口负压治疗来治疗和促进纵隔炎的恢复。
结论
遵循AATS指南可预防胸骨伤口感染和纵隔炎。实施这些干预措施需要外科医生、麻醉师、转诊医生、护士以及手术室和重症监护室人员组成的多学科团队共同努力。
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