Department of Surgery, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic.
Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic.
Ann Thorac Cardiovasc Surg. 2022 Jun 20;28(3):171-179. doi: 10.5761/atcs.oa.21-00147. Epub 2022 Mar 8.
The aims of this work were the retrospective analysis of a cohort of patients with acute mediastinitis treated at the authors' worksite over a 15-year period and the identification of factors that significantly affect the outcomes of the therapy.
During the period 2006-2020, 80 patients with acute mediastinitis were treated. Within the cohort, the following were observed: the causes and the type of acute mediastinitis, length of anamnesis, comorbidities, diagnostic methods, time from the diagnosis to surgery, types and number of surgical procedures, results of microbiological tests, complications, and outcomes of the treatment.
The most common type of acute mediastinitis was descending mediastinitis (48.75%). A total of 116 surgical procedures were performed. Ten patients in the cohort died (12.5%). Patients older than 60 years were at a 6.8 times higher risk of death. Patients with more than two comorbidities were at a 14.3 times higher risk of death. The presence of yeasts in the culture material increased the risk of death by 4.4 times.
Early diagnosis, removal of the cause of mediastinitis, sufficient mediastinal debridement, and multiple drainage thereof with the possibility of continual postoperative lavage are essential for the successful treatment of acute mediastinitis.
本研究旨在回顾性分析在作者单位治疗的急性纵隔炎患者队列，并确定对治疗结果有显著影响的因素。
在 2006 年至 2020 年期间，共治疗了 80 例急性纵隔炎患者。在队列中观察了以下内容：急性纵隔炎的病因和类型、病史长度、合并症、诊断方法、从诊断到手术的时间、手术类型和次数、微生物学检查结果、并发症以及治疗结果。
最常见的急性纵隔炎类型为下行性纵隔炎（48.75%）。共进行了 116 次手术。队列中有 10 例患者死亡（12.5%）。60 岁以上的患者死亡风险增加 6.8 倍。有两种以上合并症的患者死亡风险增加 14.3 倍。培养物中存在酵母使死亡风险增加 4.4 倍。
早期诊断、去除纵隔炎的病因、充分的纵隔清创以及多次引流并可能持续术后冲洗对于成功治疗急性纵隔炎至关重要。
