骨蜡与再生氧化纤维素材料在老年女性心内直视术胸骨止血中的应用

背景：再生氧化纤维素已成功应用于神经外科、耳鼻喉科等手术止血中，效果确切，但应用于心脏手术胸骨止血尚未见报道。 目的：对比观察再生氧化纤维素与传统胸骨止血材料骨蜡在减少老年女性心内直视术后胸骨出血中止血及预防胸骨感染效果的差异。 方法：纳入68例60岁以上女性接受正中开胸体外循环下心内直视术患者，分为2组：再生氧化纤维素组胸骨创面及骨髓腔内填充并覆盖再生氧化纤维素，对照组涂抹医用骨蜡。记录手术时间、关胸时间、体外循环时间、术后引流量、输血量、出血再次开胸例数、平均住院时间、胸骨裂开例数、胸骨感染例数、切口拆线时间以及切口感染例数。 结果与结论：两组术后在手术时间、关胸时间、引流量、输血量、出血再次开胸方面，差异有显著性意义(P < 0.05)，再生氧化纤维素组更有优势；其余指标两组差异无显著性意义。提示再生氧化纤维素作为新型胸骨止血材料，可常规用于体外循环后胸骨创面止血，效果确切，近期结果观察显示安全性较高。

Effects of bone wax and oxidized regenerated cellulose on the hemostasis of the sternum in elderly women undergoing open heart surgery

BACKGROUND:Oxidized regenerated cellulose has been used in neurological surgery and otolaryngology, but there is no report about oxidized regenerated cellulose applied in heart surgery for sternal bleeding. OBJECTIVE:To compare the effects of oxidized regenerated cellulose and bone wax on sternal bleeding and infections during open heart surgery in old women. METHODS:Totally 68 female patients over 60 years undergoing open heart surgery were divided into oxidized regenerated cellulose group and bone wax group. The sternal wound and bone marrow cavity of the former group was filled with oxidized regenerated cellulose and bone wax group with medical bone wax. Recording operating time, cardiopulmonary bypass time, time of closing chest, total drainage volume, re-exploration for bleeding, the volume of blood transfusion, suture removal time, average hospital stay, postoperative sternal wound healing were recorded. RESULTS AND CONCLUSION:The comparison between two groups in operating time, time of closing chest, total drainage volume, re-exploration for bleeding, the volume of blood transfusion was significantly different (P < 0.05). These indexes were improved dramatically in the oxidized regenerated cellulose group. The mortality, suture removal time, average hospital stay and postoperative sternal wound healing were no significantly different between two groups. Oxidized regenerated cellulose as a new material for sternal hemostasis can be routinely used after cardiopulmonary bypass, and the early results of the study showed its effectiveness and safety.