بررسي عفونت استرنوم متعاقب جراحي عروق كرونر در مركز قلب مازندران

Sternal Wound Infection after Coronary Artery Bypass Grafting in Mazandaran Heart Center

سابقه و هدف: عفونت استرنوم عارضه اي جدي به دنبال استرناتومي مياني مي باشد كه باعث افزايش مرگ و مير بيمارستاني مي گردد. در اين نگارش به عفونت استرنوم در بخش جراحي مركز قلب مازندران و چگونگي درمان آن مي پردازيم. مواد و روش ها: در يك مطالعه توصيفي، از فروردين 1391 تا اسفند 1394، تعداد 4725 بيمار تحت عمل جراحي پيوند عروق كرونر قرار گرفتند. اطلاعات مربوط به سن، جنس، فاكتورهاي خطر ابتلا به ايسكمي قلبي و عوامل موثر در ايجاد عفونت ضمن عمل جراحي و نوع عفونت استرنوم و روش درماني آن ها مورد بررسي قرار گرفتند. درمان هاي انجام شده بر اساس نوع عفونت و زمان تشخيص آن در نظر گرفته شده اند. داده هاي آماري با نرم افزار Med calc بررسي شده و 0/05

Background and purpose: Sternal Wound Infection (SWI) is a serious complication of median sternotomy that increases the rate of mortality. We report our experience of managing SWI in a regional cardiothoracic unit in Mazandaran province, Iran. Materials and methods: We prospectively studied 4725 patients who underwent isolated coronary artery bypass grafting between March 2012 and March 2015. Information about age, sex, morbidities, surgical factors and nature of sternal wound infection were recorded. Treatment options were stratified by nature of infection, and timing and nature of management. Data analysis was done using Med calc soft ware and p-values less than 0.5 were considered significant. Results: Sternal wound infection occurred in 49 (1%) patients. There were 26 (0.55%) superficial and 23 (0.48%) deep SWIs. SWI patients were found to be mainly females, with diabetes or hypertension, high body mass indices and longer aortic cross-clamp time. All patients with superficial SWI were managed by skin debridement and closure. Patients with deep SWI who had surgery within 48 hours of diagnosis were managed using skin and bone debridement and sternal rewiring following mediastinal drain. The mortality rate was found to be high in patients with SWI (12.2%). Conclusion: Low sternal wound infection can be achieved with an ongoing focus on appropriate infection control. SWI significantly increases the risk of mortality which could be reduced through early intervention.