Sorm Zdenek, Vobornik Martin, Dergel Martin, Cermakova Eva, Harrer Jan, Gofus Jan
Department of Cardiac Surgery, Charles University, Faculty of Medicine and University Hospital in Hradec Kralove, Czech Republic.
Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic.
Kardiochir Torakochirurgia Pol. 2023 Jun;20(2):67-71. doi: 10.5114/kitp.2023.129551. Epub 2023 Jul 26.
The effect of bone wax on sternal infection and intraoperative bleeding in off-pump coronary surgery has not been reported in current literature.
To prospectively evalute this in a cohort of high risk patients undergoing off-pump coronary artery surgery at our institution. The potential impact on cell saver utilization was also studied.
A prospective randomized study was performed in 58 diabetic patients operated on for two-vessel coronary artery disease by the off-pump technique. They were randomly assigned to the wax or no-wax group.
There was no significant difference in intraoperative blood loss between the wax (550 ml) and no-wax group (750 ml; = 0.0711). In multivariate analysis the absence (non-use) of bone wax (odds ratio = 3.9 (1.12-13.51), = 0.027) and preoperative creatinin level (odds ratio = 1.1 (0.99-1.03), = 0.03) were identified as independent predictors of blood loss ≥ 750 ml. The number of red blood cell units during hospital stay was similar in both groups ( = 0.42). Wound healing complications were not observed in either group.
The use of bone wax does not lead to a higher risk of sternal wound infection. It may reduce the risk of high intraoperative blood loss, thus avoiding the need of a cell saver during off-pump coronary surgery. However, this influence remains questionable.
目前文献中尚未报道骨蜡在非体外循环冠状动脉手术中对胸骨感染和术中出血的影响。
在我院接受非体外循环冠状动脉手术的高危患者队列中对其进行前瞻性评估。还研究了对血液回收机使用的潜在影响。
对58例接受非体外循环技术双支冠状动脉疾病手术的糖尿病患者进行前瞻性随机研究。他们被随机分为使用骨蜡组和不使用骨蜡组。
使用骨蜡组（550毫升）与不使用骨蜡组（750毫升；P = 0.0711）术中失血量无显著差异。多因素分析显示，未使用骨蜡（比值比 = 3.9（1.12 - 13.51），P = 0.027）和术前肌酐水平（比值比 = 1.1（0.99 - 1.03），P = 0.03）被确定为失血量≥750毫升的独立预测因素。两组住院期间红细胞输注单位数量相似（P = 0.42）。两组均未观察到伤口愈合并发症。
使用骨蜡不会导致胸骨伤口感染风险增加。它可能降低术中大量失血的风险，从而在非体外循环冠状动脉手术中无需使用血液回收机。然而，这种影响仍存在疑问。
