Yang Jian, Zhang Bin, Qu Chengliang, Liu Li, Song Yanyan
Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, People's Republic of China.
Infect Drug Resist. 2022 Sep 6;15:5249-5256. doi: 10.2147/IDR.S381422. eCollection 2022.
To investigate the risk factors of deep sternal wound infection (DSWI) after off-pump coronary artery bypass grafting and its prevention and treatment strategy.
The clinical data of 465 patients who underwent OPCABG with a median chest incision were retrospectively analyzed. The patients were divided into the observation group (with DSWI, 32 cases) and the control group (without DSWI, 433 cases) according to the occurrence of DSWI. The preoperative, intraoperative, and postoperative clinical data relevant to DSWI were collected in both groups. The univariate and multivariate logistic regression analyses were adopted to analyze the risk factors for DSWI after OPCABG and investigateand its prevention and treatment strategy.
DSWI occurred in 32 cases with an incidence of infection of 6.89%. There were 5 cases died in the observation group (with DSWI), the overall mortality rate was 1.07% and the intra-group mortality rate was 15.6%. There were 16 cases died in the control group (without DSWI) because of low cardiac output syndrome and multiple organ failure, the overall and intra-group mortality rates were 3.44% and 3.69% respectively. By analyzing the risk factors of DSWI between the two groups, the differences in age, body mass index (BMI), history of diabetes mellitus (DM), operation time, tracheal intubation time, time of stay in thecardiac care unit, blood transfusion (blood plasma)>800mL, blood transfusion (erythrocyte suspension)>6um, secondary thoracotomy were statistically significant between the observation and control groups ( < 0.05 in all).
Obesity, history of DM, prolonged operation time and tracheal intubation time, time of stay in CCU, utilization of blood product and secondary thoracotomy were DSWI independent risk factors after OPCABG.Some preventive measure should been implemented to reduce the incidence of DSWI, such as shorter operation time and tracheal intubation time, reducing the utilization of blood product.
探讨非体外循环冠状动脉旁路移植术后深部胸骨伤口感染（DSWI）的危险因素及其防治策略。
回顾性分析465例行正中开胸非体外循环冠状动脉旁路移植术患者的临床资料。根据是否发生DSWI将患者分为观察组（发生DSWI，32例）和对照组（未发生DSWI，433例）。收集两组与DSWI相关的术前、术中和术后临床资料。采用单因素和多因素logistic回归分析非体外循环冠状动脉旁路移植术后DSWI的危险因素并探讨其防治策略。
32例发生DSWI，感染发生率为6.89%。观察组（发生DSWI）死亡5例，总死亡率为1.07%，组内死亡率为15.6%。对照组（未发生DSWI）因低心排血量综合征和多器官功能衰竭死亡16例，总死亡率和组内死亡率分别为3.44%和3.69%。通过分析两组间DSWI的危险因素，观察组和对照组在年龄、体重指数（BMI）、糖尿病史（DM）、手术时间、气管插管时间、在心脏监护病房的停留时间、输血量（血浆）>800mL、输血量（红细胞悬液）>6U、二次开胸方面的差异具有统计学意义（均P<0.05）。
肥胖、DM史、手术时间和气管插管时间延长、在心脏监护病房的停留时间、血液制品的使用和二次开胸是非体外循环冠状动脉旁路移植术后DSWI的独立危险因素。应采取一些预防措施来降低DSWI的发生率，如缩短手术时间和气管插管时间，减少血液制品的使用。
