摘要
目的总结小儿心脏外科手术后累及胸骨的深部切口感染的外科治疗方法。方法2010年1月至2019年12月共31866例年龄<7岁的患儿在阜外心血管病医院接受经胸骨正中切口行心脏手术,新生儿共387例。31866例患儿中,0.15%(47/31866)的患儿发生了累及胸骨的深部切口感染;不同年龄患儿术后深部切口感染的发生率分别为新生儿2.33%(9/387),2~6月龄患儿0.15%(6/4018),6~12月龄患儿0.09%(6/7010),1~3岁患儿0.13%(15/11511),3~7岁患儿0.12%(11/8940)。47例患儿中,男30例,女17例;年龄为(1.98±2.03)岁;体重为(10.55±6.24)kg。复杂先天性心脏病占74.5%(35/47);新生儿占19.1%(9/47),其中2例有延迟关胸病史;心脏手术后15 d内发现伤口感染并进行清创手术的患儿占29.8%(14/47),心脏手术后15~30 d发现伤口感染并进行清创手术的患儿占23.4%(11/47),>30 d的占46.8%(22/47)。结果新生儿术后深部切口的感染发生率明显高于其他年龄患儿术后深部切口感染发生率,差异具有统计学意义(P=0)。47例患儿均为胸骨正中切口,感染确诊后即开放原手术切口引流换药,待伤口创面清洁、肉芽新鲜后送入手术室接受清创手术,清创手术距离上次心脏手术的时间为(126.89±310.53)d,范围为4~1997 d,其中感染时间>30 d才进行清创手术的患儿的感染复发率高,需要进行多次清创的患儿占50.0%(11/22),而且只有59.1%(13/22)的患儿能够保留胸骨。本研究中,29.8%(14/47)的患儿需要在院内接受两次以上的清创手术;25.5%(12/47)的患儿因感染较重无法保留胸骨故行胸大肌肌瓣转移手术;14.9%(7/47)的患儿因感染严重渗出较多或无法配合床旁换药,在清创手术前使用了封闭式持续负压吸引治疗。对31例患儿的伤口分泌物进行了细菌学培养,其中18例培养出革兰氏阳性球菌,主要为表皮葡萄球菌和金黄色葡萄球菌,9例未检出致病菌,余4例培养出革兰氏阴性杆菌。本研究的患儿无住院死亡病�
Objective To summarize the surgical treatments of deep sternal wound infection(DSWI)in children aged under 7 years after pediatric cardiac surgery.Methods From January 2010 to December 2019,a total of 31866 children underwent cardiac surgery through a median sternal incision.There were 387 neonates.Among them,0.15%(47/31866)developed deep incision infection involving sternum.The incidence of DSWI in children of different ages was 2.33%(9/387)for neonates,0.15%(6/4018)for children aged 2-6 months,0.09%for children aged 6-12 months(6/7010),0.13%(15/11511)for children aged 1-3 and 0.12%(11/8940)for children aged 3-7.Among 47 children,there are 30 boys and 17 girls;their age was(1.98±2.03)years;their weight(10.55±6.24)kg.Complex congenital heart disease accounted for 75%of all cases.There were 9 neonates(19.1%),21 infants(44.7%)aged under 1 year,14 infants(29.8%)with wound infection and debridement within 15 days after an initial operation,11 infants(23.4%)with wound infection and debridement 15 to 30 days after an initial operation and 22 infants(46.8%)over 30 days.Results The incidence rate of postoperative deep incision infection in newborns was significantly higher than that in children of other ages,and the difference had statistical significance(P=0).All 47 children had a median sternotomy,and the original surgical incision was opened for drainage and dressing change immediately after the diagnosis of infection.After the wound was clean and granulation was fresh,they were sent to the operating room for debridement surgery.The time from debridement surgery to the last cardiac surgery was(126.89±310.53)d,ranging from 4 to 1997 days.Among them,the children with infection time>30 days who underwent debridement surgery had a high recurrence rate of infection,50.0%(11/22)required multiple debridement,and only 59.1%(13/22)of the children were able to preserve the sternum.In this study,29.8%(14/47)of the children required more than two debridement procedures in the hospital;25.5%(12/47)of the children underwent pect
作者
林野
李守军
李汉美
芮璐
王旭
Lin Ye;Li Shoujun;Li Hanmei;Rui Lu;Wang Xu(Department of Cardiovascular Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2021年第10期883-887,共5页
Chinese Journal of Pediatric Surgery
基金
国家重点研发计划(2017YFC1308100)
中国医学科学院医学与健康科技创新工程(2020-I2M-C&T-A-009)。
关键词
外科伤口感染
胸骨
心脏外科手术
Surgical wound infection
Sternum
Cardiac surgical procedures
