儿童先心病手术后胸骨-纵隔感染的预防和治疗

目的 总结本中心针对儿童先心病手术后出现胸骨-纵隔感染而采取的预防及治疗经验. 方法 统计本中心2010年10月至2012年3月收治的15例经胸部正中开胸行心脏手术后出现胸骨-纵隔感染的患儿,该组患儿术后均出现发热,切口分泌物增多,伤口经久不愈,部分患儿出现胸骨松动,CRP及WBC均高于正常值.部分患儿的切口分泌物或血培养呈现阳性.明确胸骨-纵隔感染后,即采取敞开切口充分引流,去除异物及坏死组织,术中或术后予以0.5％～1％的碘伏冲洗,选择合适抗生素,加强全身营养支持疗法. 结果 全组无一例死亡病例,所有患儿切口均愈合,3例切口瘢痕形成,但未行皮瓣移植.其中1例患儿,两次均以胸骨-纵隔后感染入院,两次入院时间相隔8d,总住院时间达93 d. 结论 儿童先心病手术后出现胸骨-纵隔感染,尽快诊断是良好治疗的前提,而综合性的治疗方法,是防止出现严重后果的关键,同时,对于儿童先心病患者,要更注重于预防措施才能根本上降低胸骨-纵隔感染的发生率,因此在手术中及手术后采取合适的技术尤其重要.

Prevention and treatment of sternum-mediastinal infections after congenital heart disease operations in children

Objetive To summarize the experience of prevent and therapy for the sternum-mediastinal infections after congenital heart disease in Children.Methods Between Oct 2010 to Mar 2012 15 children with stemum-mediastinal infections after open-heart operation had been analyzed.All the children had postoperative fever,increased wound secretions,outlasted the wound healing,and some children＇s sternum were loose,the values of CRP and WBC were higher than normal.The incision secretions or blood cultures in some children were positive.Open incision and drain adequately when sternum-mediastinal infection were found,and remove the foreign bodies and necrotic tissue.Intraoperative or postoperative rinse cleanly with 0.5％ to 1％ iodine.At last,select the appropriate antibiotics and nutritional support therapy.Results None of children in this group died and the incisions in all children were healing.3 cases of them had incisional scar.1 cases had the sternum-Mediastinal infection again,the total time of treatment was up to 93 d.Conclusion The premise for good treatment is early diagnosis for the children with sternum-mediastinal after congenital heart disease surgery.The comprehensive treatment is critical to prevent serious consequences,meanwhile,the protective treatment for these children was to radically reduce the sternum-mediastinal infection rate,so to take the appropriate technology in the operations and after operations was more important.