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首页> 外文期刊>Journal of cardiac surgery. >Sternal wound complications in patients undergoing orthotopic heart transplantation
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Sternal wound complications in patients undergoing orthotopic heart transplantation

机译：接受原位心脏移植患者的胸骨伤口并发症

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Abstract Purpose The incidence and management of sternal wound complications in patients undergoing orthotopic heart transplantation (OHT) is not well studied. We report outcomes in heart transplant patients who developed sternal infections requiring reoperations. Methods From 2004 to 2013, 437 patients underwent OHT at a single institution. In a retrospective review, patients who developed sternal infections (Infection group, n?=?27) were compared with those without (Control group, n?=?410). Results Sternal infection rate was 6.2% (n?=?27). Demographics were similar (Table 1). Infection group had higher rates of COPD 25% vs 13%, P ?=?0.03, and previous cardiac surgery via median sternotomy 28% vs 15%, P ?=?0.03. Infection group had a greater incidence of prolonged ventilation, 44% vs 31%, P ?=?0.2, renal failure 56% vs 24%, P ?=?0.001, dialysis requirement 30% vs 10%, P ?=?0.006, permanent stroke 11% vs 2%, P ?=?0.02, perioperative myocardial infarction 4% vs 0.2%, P ?=?0.09. The infection group had a longer ICU stay (524 ?+? 410 vs 187 ?+? 355?hours, P ?=?0.001) and hospitalization (59 ?+? 28 vs 0.29 ?+? 43 days, P ?=?0.001). In‐hospital/30‐day mortality was 30% vs 19%, P ?=?0.2. The mean time for sternal reoperation at 44 ?+? 50 days. Deep wound infection (41%) and sternal dehiscence (22%) were common presentations. Causative organisms were Enterobacter (22%), Klebsiella (15%), and Pseudomonas (15%). Vancomycin (44%), 4th generation cephalosporin (37%), and fluoroquinolones (30%) were the most commonly used antibiotics. Surgical treatment included sternal debridement with pectoralis muscle flap (52%), primary closure (18%), and omental flap (11%). Conclusion Sternal wound infections impart a significant burden on patients with OHT. Causative organisms are predominantly virulent gram‐negative bacteria. Therefore, a high index of suspicion must be maintained for early detection and treatment.
机译：摘要目的，胸骨伤口并发症的发病率和管理在接受原位心脏移植（OHT）的患者中尚未得到很好的研究。我们报告了心脏移植患者的结果，该患者制定了需要重新进展的胸骨感染。方法从2004年到2013年，437名患者在一个机构接受了OHT。在回顾性审查中，与没有（对照组，N？= 410）的那些进行比较胸骨感染（感染组，N？= 27）的患者。结果胸骨感染率为6.2％（n？=？27）。人口统计学是相似的（表1）。感染组的COPD 25％率较高，P <= 0.03，先前的心脏手术通过中位数术骨术28％vs 15％，p？= 0.03。感染组延长通气的发生率更大，44％vs 31％，p？= 0.2，肾功能衰竭56％vs 24％，p？= 0.001，透析要求30％vs 10％，p？= 0.006，永久行程11％vs 2％，p？= 0.02，围手术期心肌梗死4％vs0.2％，p？= 0.09。感染组的ICU住宿更长（524？+ 410 vs 187？+ 355？小时，p？= 0.001）和住院（59？+？28 Vs 0.29？+ 43天，p？= 0.001 ）。在医院/ 30天死亡率为30％vs 19％，p？= 0.2。胸骨重新组合的平均时间在44？+？ 50天。深伤感染（41％）和胸骨裂开（22％）是常见的演示文稿。致病生物是肠杆菌（22％），Klebsiella（15％）和假单胞菌（15％）。万古霉素（44％），第4代头孢菌素（37％）和氟喹诺酮（30％）是最常用的抗生素。手术治疗包括胸骨肌肉皮瓣（52％），初级闭合（18％）和题瓣（11％）的胸骨清创。结论胸骨伤口感染赋予OHT患者的重大负担。致病生物主要是毒性革兰氏阴性细菌。因此，必须保持高度怀疑的怀疑索引以进行早期检测和治疗。

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