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心脏手术中的手术部位感染

Surgical Site Infection in Cardiac Surgery.

作者信息

Zukowska Agnieszka, Zukowski Maciej

机构信息

Department of Infection Control, Regional Hospital Stargard, 73-110 Stargard, Poland.

Department of Anesthesiology, Intensive Care and Acute Intoxication, Pomeranian Medical University, 70-204 Szczecin, Poland.

出版信息

J Clin Med. 2022 Nov 26;11(23):6991. doi: 10.3390/jcm11236991.

Abstract

Surgical site infections (SSIs) are one of the most significant complications in surgical patients and are strongly associated with poorer prognosis. Due to their aggressive character, cardiac surgical procedures carry a particular high risk of postoperative infection, with infection incidence rates ranging from a reported 3.5% and 26.8% in cardiac surgery patients. Given the specific nature of cardiac surgical procedures, sternal wound and graft harvesting site infections are the most common SSIs. Undoubtedly, DSWIs, including mediastinitis, in cardiac surgery patients remain a significant clinical problem as they are associated with increased hospital stay, substantial medical costs and high mortality, ranging from 3% to 20%. In SSI prevention, it is important to implement procedures reducing preoperative risk factors, such as: obesity, hypoalbuminemia, abnormal glucose levels, smoking and carriage. For decolonisation of carriers prior to cardiac surgery, it is recommended to administer nasal mupirocin, together with baths using chlorhexidine-based agents. Perioperative management also involves antibiotic prophylaxis, surgical site preparation, topical antibiotic administration and the maintenance of normal glucose levels. SSI treatment involves surgical intervention, NPWT application and antibiotic therapy.

摘要

手术部位感染(SSIs)是外科手术患者最严重的并发症之一,与较差的预后密切相关。由于心脏外科手术的侵袭性,术后感染风险特别高,心脏手术患者的感染发生率据报道在3.5%至26.8%之间。鉴于心脏外科手术的特殊性,胸骨伤口和移植物获取部位感染是最常见的手术部位感染。毫无疑问,心脏手术患者的深部胸骨伤口感染(DSWIs),包括纵隔炎,仍然是一个重大的临床问题,因为它们与住院时间延长、大量医疗费用和高死亡率相关,死亡率在3%至20%之间。在预防手术部位感染方面,实施减少术前危险因素的措施很重要,例如:肥胖、低白蛋白血症、血糖异常、吸烟和携带病菌。对于心脏手术前病菌携带者的去定植,建议使用鼻用莫匹罗星,并使用含氯己定的制剂进行沐浴。围手术期管理还包括抗生素预防、手术部位准备、局部抗生素给药和维持正常血糖水平。手术部位感染的治疗包括手术干预、负压伤口治疗(NPWT)应用和抗生素治疗。

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Surgical Site Infection in Cardiac Surgery.心脏手术中的手术部位感染
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