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小儿心脏外科学术文献综述:心脏手术切口管理。

Management of pediatric cardiac surgery wound: a literature review.

机构信息

Dr.ssa in Infermieristica.

Independent researcher.

出版信息

Acta Biomed. 2021 Sep 2;92(4):e2021203. doi: 10.23750/abm.v92i4.11269.

DOI:10.23750/abm.v92i4.11269
PMID:34487083
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8477079/
Abstract

BACKGROUND

Sternal wound infection is a severe complication of cardiac surgery in the pediatric population (0-18 years old) that can lead to increased morbidity, mortality, and prolonged hospitalization. Health professionals have the ability to perform some interventions during the pre, intra and post-surgery to correctly manage sternal wounds, with the goal of preventing infections.

OBJECTIVES

To identify and discuss current best practice in the prevention, incidence, and treatment of infections of the cardiac surgery site in the pediatric population.

METHODS

Between February 20th 2021 and February 28th 2021 we consulted the PubMed database adopting full text, 20 years, Humans, English, Child aged 0 to 18 years as criteria. Twenty articles out of sixty-six were considered relevant to this study. These were divided into four themes.

RESULTS

All studies highlight the lack of standard guidelines for managing pediatric patients undergoing cardiac surgery. Some centers developed protocols for managing antibiotic prophylaxis supported by measurable interventions; others implemented infection surveillance systems involving families taking care of patients after hospital discharge.

DISCUSSIONS

the identification of healthcare-associated infections in the pediatric population after cardiac surgery is useful in all peri-operative phases. The limited and restricted literature connected to single centers, with relatively small sample sizes, the use of a single database.

CONCLUSION

There is a lack of standard guidelines. The prevention of site infection ought to the goal of reducing surgical site infections. Building a network between the multidisciplinary staff and the pediatric patient's family improves the infection surveillance system, reducing the incidence of infections.

摘要

背景

胸骨伤口感染是儿科人群(0-18 岁)心脏手术后的一种严重并发症,可导致发病率、死亡率增加和住院时间延长。卫生专业人员在手术前、手术中和手术后有能力进行一些干预,以正确管理胸骨伤口,从而预防感染。

目的

确定并讨论儿科人群心脏手术部位感染的预防、发生率和治疗的当前最佳实践。

方法

在 2021 年 2 月 20 日至 2021 年 2 月 28 日期间,我们采用全文、20 年、人类、英语、0 至 18 岁儿童为标准,在 PubMed 数据库中进行了检索。在 66 篇文章中,有 20 篇被认为与本研究相关。这些文章分为四个主题。

结果

所有研究都强调缺乏管理接受心脏手术的儿科患者的标准指南。一些中心制定了管理抗生素预防的方案,这些方案得到了可衡量干预措施的支持;其他中心则实施了感染监测系统,涉及照顾出院后患者的家庭。

讨论

在心脏手术后的儿科人群中识别医疗保健相关感染在所有围手术期阶段都很有用。与单一中心相关的有限和受限文献,样本量相对较小,使用单一数据库。

结论

缺乏标准指南。预防部位感染应该是减少手术部位感染的目标。在多学科工作人员和儿科患者家庭之间建立网络可以改善感染监测系统,降低感染发生率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/080f/8477079/d1c34b065851/ACTA-92-203-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/080f/8477079/d1c34b065851/ACTA-92-203-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/080f/8477079/d1c34b065851/ACTA-92-203-g001.jpg

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本文引用的文献

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Pediatr Cardiol. 2020 Oct;41(7):1402-1407. doi: 10.1007/s00246-020-02396-x. Epub 2020 Jun 18.
2
Efforts to Reduce Infections in Delayed Sternal Closure Patients: A Survey of Pediatric Practice.努力减少延迟性胸骨闭合患者的感染:儿科实践调查。
World J Pediatr Congenit Heart Surg. 2020 May;11(3):310-315. doi: 10.1177/2150135120907372.
3
Antibiotic Prophylaxis for Open Chest Management After Pediatric Cardiac Surgery.
新生儿和儿童心脏及胸外科手术患者围手术期预防:一项兰德/加州大学洛杉矶分校适宜性方法共识研究。
Antibiotics (Basel). 2022 Apr 21;11(5):554. doi: 10.3390/antibiotics11050554.
小儿心脏手术后开胸管理的抗生素预防。
Pediatr Crit Care Med. 2019 Sep;20(9):801-808. doi: 10.1097/PCC.0000000000001995.
4
A Postoperative Care Bundle Reduces Surgical Site Infections in Pediatric Patients Undergoing Cardiac Surgeries.一个术后护理套餐可降低接受心脏手术的儿科患者的手术部位感染率。
Jt Comm J Qual Patient Saf. 2019 Mar;45(3):156-163. doi: 10.1016/j.jcjq.2018.05.009. Epub 2018 Aug 29.
5
Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients.预防小儿心脏手术患者胸骨伤口感染的多中心质量改进项目。
World J Pediatr Congenit Heart Surg. 2017 Jul;8(4):453-459. doi: 10.1177/2150135117713741.
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Paediatr Anaesth. 2017 Aug;27(8):849-855. doi: 10.1111/pan.13169. Epub 2017 May 15.
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Reducing Pediatric Sternal Wound Infections: A Quality Improvement Project.降低小儿胸骨伤口感染率:一项质量改进项目。
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