临床外科杂志 ›› 2019, Vol. 27 ›› Issue (11): 946-949.doi: 10.3969/j.issn.1005-6483.2019.11.007

• 论著 • 上一篇    下一篇

心血管外科术后胸部切口愈合不良高危因素分析

  

  • 出版日期:2019-11-20 发布日期:2019-11-20

Analysis of risk factors for thoracic incision poor healing after cardiovascular surgery

  • Online:2019-11-20 Published:2019-11-20

摘要: 目的:探讨心血管外科术后胸部切口愈合不良的高危因素。方法:2010年4月~2018年4月手术病人258例,愈合不良组86例,为术后胸部切口愈合不良病人,对照组172例,为同期切口愈合良好病人,比较两组病人围手术期各指标差异。结果:两组年龄>70岁、女性、复合手术、术前备皮、可吸收缝线使用、医用手术薄膜的使用率、缝合皮肤前生理盐水冲洗切口等因素比较,差异无统计学意义(P>0.05);两组低蛋白血症发生率、术后射血分数<40%、急诊手术、非计划再次手术、乳内动脉使用、中量心包积液、术中体温<34℃、手术时间>4小时、体外循环时间>2小时等指标比较,差异有统计学意义(P<0.05)。结论:病人性别、年龄>70岁、复合手术、术前备皮等因素与切口愈合不良无明显相关,营养不良、器官功能不全、手术时机、切口局部环境等为切口愈合不良的高危因素。

关键词: 切口感染, 切口愈合不良, 持续负压引流, 心外科

Abstract: Objective:To investigate the high risk factors of poor wound healing after cardiovascular surgery,and to analyze these high risk factors and their countermeasures.Methods:The medical records of patients undergoing cardiovascular surgery from April 2010 to April 2018 were analyzed.86 patients with poor wound healing after operation were selected as treatment group and 172 patients with good wound healing as control group.The data of perioperative period were compared and analyzed between the two groups.Results:The two groups of patients in over 70 years old,female patients,combined surgery,preoperative skin preparation,absorbable suture use,the utilization rate of surgical membrane,the saline irrigation incision before suture have no significant difference(P>0.05).There were significant differences in incidence of hypoproteinemia in the two groups,ejection fraction<40 after operation,emergency surgery,unplanned reoperation,the use of internal mammary artery,pericardial effusion,temperature<34℃,operation time>4h and cardiopulmonary bypass time>2h(P<0.05).〖WTHZ〗Conclusion:Gender,age>70years old,combined operation,skin preparation before operation are not significantly related to wound healing,but malnutrition,organ dysfunction,operation timing,incision local environment are the high risk factors of incision healing.

Key words: incision infection, poor healing, vacuum sealing drainage, cardiac surgery

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