• 武警后勤學(xué)院附屬醫(yī)院心胸外科, 天津 300162;

目的  介紹采用真空封閉引流法( VAC)治療心肺手術(shù)后胸部切口裂開 ,總結(jié)其初期臨床經(jīng)驗(yàn)。方法  回顧性分析 2010年 10月至 2011年 10月天津武警后勤學(xué)院附屬醫(yī)院 12例心肺手術(shù)后胸部切口裂開患者經(jīng) VAC治療的臨床資料,男 7例,女 5例;平均年齡 64.3(39~ 80)歲。均經(jīng)胸骨正中切口或側(cè)胸切口徑路行心肺手術(shù)。術(shù)后手術(shù)切口裂開程度均達(dá)胸骨或肋骨。胸部切口經(jīng)清創(chuàng)后安裝 VAC裝置海綿,使用間斷負(fù)壓儀治療,7~ 10 d更換切口負(fù)壓海綿 1次。結(jié)果  所有使用 VAC治療的患者平均更換 VAC海綿材料 2次,治療中切口周圍組織水腫消退,切口肉芽新鮮,所有患者全身狀況改善,患者可以下床,生活自理,不再使用抗生素。住院醫(yī)師的主要工作變成每日檢查負(fù)壓輔助裝置工作是否正常,患者不再有恐懼和每天換藥時(shí)的疼痛感。所有患者經(jīng)治療后痊愈出院,均在門診進(jìn)行隨訪,平均隨訪時(shí)間 7個(gè)月,切口愈合牢固,效果滿意。結(jié)論  VAC使用方便,能迅速促進(jìn)切口愈合、減輕局部切口和全身炎性反應(yīng),加速患者康復(fù),同時(shí)減輕了住院醫(yī)師的工作量,值得臨床推廣應(yīng)用。

引用本文: 于洪泉,楊學(xué)勇,李濱等. 采用真空封閉引流法治療心肺手術(shù)后切口裂開. 中國胸心血管外科臨床雜志, 2012, 19(3): 280-282. doi: 復(fù)制

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2.  Crabtree TD, Codd JE, Fraser VJ, et al. Multivariate analysis of risk factors for deep and superficial sternal infection after coronary artery bypass grafting at a tertiary care medical center. Semin Thorac Cardiovasc Surg, 2004, 16 (1): 53-61.
3.  Sarr MG, Gott VL, Townsend TR. Mediastinal infection after cardiac surgery. Ann Thorac Surg, 1984, 38 (4): 415-423.
4.  毛小泉, 謝文揚(yáng). 感染傷口愈合過程中負(fù)壓引流對(duì)成纖維細(xì)胞的影響. 廣西醫(yī)學(xué), 2009, 31 (7):924- 926.
5.   阿瑪?shù)拢?蔡林, 朱曉彬, 等. 不同負(fù)壓值的封閉式引流對(duì)豬背軟組織創(chuàng)面中綠膿桿菌生長的影響. 武漢大學(xué)學(xué)報(bào)(醫(yī)學(xué)版), 2009, 30 (3):386-389.
6.  Tang AT, Okri SK, Haw MP. Vacuum-assisted closure to treat deep sternal wound infection following cardiac surgery. J Wound Care, 2000, 9 (5): 229-230.
7.  Hersh RE, Kaza AK, Long SM, et al. A technique for the treatment of sternal infections using the Vacuum Assisted Closure device. Heart Surg Forum, 2001, 4 (3): 211-215.
8.  Sjögren J, Gustafsson R, Nilsson J, et al. Clinical outcome after poststernotomy mediastinitis: vacuum-assisted closure versus conventional treatment. Ann Thorac Surg, 2005, 79 (6): 2049-2055.
9.  Agarwal JP, Ogilvie M, Wu LC, et al. Vacuum-assisted closure for sternal wounds: a first-line therapeutic management approach. Plast Reconstr Surg, 2005, 116 (4): 1035-1040.
10.  朱禮霞, 蔣琪霞. 負(fù)壓封閉輔助傷口閉合技術(shù)的研究進(jìn)展.醫(yī)學(xué)研究生學(xué)報(bào), 2010, 23 (6):658-661.
11.  World Union of Wound Healing Societies (WUWHS). Principles of best practice:vacuum assisted closure, recommendations for use. London: MEP Ltd, 2008. 1-20.
  1. 1.  Eklund AM, Lyytikäinen O, Klemets P, et al. Mediastinitis after more than 10 000 cardiac surgical procedures. Ann Thorac Surg, 2006, 82 (5): 1784-1789.
  2. 2.  Crabtree TD, Codd JE, Fraser VJ, et al. Multivariate analysis of risk factors for deep and superficial sternal infection after coronary artery bypass grafting at a tertiary care medical center. Semin Thorac Cardiovasc Surg, 2004, 16 (1): 53-61.
  3. 3.  Sarr MG, Gott VL, Townsend TR. Mediastinal infection after cardiac surgery. Ann Thorac Surg, 1984, 38 (4): 415-423.
  4. 4.  毛小泉, 謝文揚(yáng). 感染傷口愈合過程中負(fù)壓引流對(duì)成纖維細(xì)胞的影響. 廣西醫(yī)學(xué), 2009, 31 (7):924- 926.
  5. 5.   阿瑪?shù)拢?蔡林, 朱曉彬, 等. 不同負(fù)壓值的封閉式引流對(duì)豬背軟組織創(chuàng)面中綠膿桿菌生長的影響. 武漢大學(xué)學(xué)報(bào)(醫(yī)學(xué)版), 2009, 30 (3):386-389.
  6. 6.  Tang AT, Okri SK, Haw MP. Vacuum-assisted closure to treat deep sternal wound infection following cardiac surgery. J Wound Care, 2000, 9 (5): 229-230.
  7. 7.  Hersh RE, Kaza AK, Long SM, et al. A technique for the treatment of sternal infections using the Vacuum Assisted Closure device. Heart Surg Forum, 2001, 4 (3): 211-215.
  8. 8.  Sjögren J, Gustafsson R, Nilsson J, et al. Clinical outcome after poststernotomy mediastinitis: vacuum-assisted closure versus conventional treatment. Ann Thorac Surg, 2005, 79 (6): 2049-2055.
  9. 9.  Agarwal JP, Ogilvie M, Wu LC, et al. Vacuum-assisted closure for sternal wounds: a first-line therapeutic management approach. Plast Reconstr Surg, 2005, 116 (4): 1035-1040.
  10. 10.  朱禮霞, 蔣琪霞. 負(fù)壓封閉輔助傷口閉合技術(shù)的研究進(jìn)展.醫(yī)學(xué)研究生學(xué)報(bào), 2010, 23 (6):658-661.
  11. 11.  World Union of Wound Healing Societies (WUWHS). Principles of best practice:vacuum assisted closure, recommendations for use. London: MEP Ltd, 2008. 1-20.