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陈东升, 刘建超, 冯泽坤, 李双磊, 何添, 张广良, 梁纯, 陈犹白, 韩岩. 胸骨正中劈开入路心脏术后并发胸部切口感染危险因素的病例对照研究[J]. 解放军医学院学报. DOI: 10.12435/j.issn.2095-5227.2023.131
引用本文: 陈东升, 刘建超, 冯泽坤, 李双磊, 何添, 张广良, 梁纯, 陈犹白, 韩岩. 胸骨正中劈开入路心脏术后并发胸部切口感染危险因素的病例对照研究[J]. 解放军医学院学报. DOI: 10.12435/j.issn.2095-5227.2023.131
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CHEN Dongsheng, LIU Jianchao, FENG Zekun, LI Shuanglei, HE Tian, ZHANG Guangliang, LIANG Chun, CHEN Youbai, HAN Yan. Factors associated with sternal wound infection after open heart surgery via sternotomy: A case-control study[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL. DOI: 10.12435/j.issn.2095-5227.2023.131
Citation: CHEN Dongsheng, LIU Jianchao, FENG Zekun, LI Shuanglei, HE Tian, ZHANG Guangliang, LIANG Chun, CHEN Youbai, HAN Yan. Factors associated with sternal wound infection after open heart surgery via sternotomy: A case-control study[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL. DOI: 10.12435/j.issn.2095-5227.2023.131
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胸骨正中劈开入路心脏术后并发胸部切口感染危险因素的病例对照研究

Factors associated with sternal wound infection after open heart surgery via sternotomy: A case-control study

    摘要
  • 摘要:
      背景  胸骨正中劈开术是开胸心脏手术的常规入路，经此入路行心脏手术的患者术后可并发胸部切口感染(sternal wound infection，SWI)，给患者造成巨大的心理和经济负担。
      目的  探索SWI发生的危险因素，积极预防并降低其发病率。
      方法  回顾性分析2011年1月至2021年1月在解放军总医院通过胸骨正中劈开入路行开胸心脏手术患者，筛选发生SWI的病例，并进行1∶4倾向性匹配。通过单因素Cox分析以及LASSO回归筛选与SWI发生有关的特征指标，综合专家意见后进行多因素Cox回归确定切口感染的独立危险因素。
      结果  5471人，其中61例患者在开胸手术后180天内发生SWI，发病率约1.11%，其中44例为SSWI, 17例为DSWI。病例组男21例，女40例，中位年龄是61岁；对照组男110例，女134例，中位年龄59岁。多因素Cox回归分析显示，体质量指数HR(95%CI)：1.07(1.00-1.14)，P=0.038、糖尿病HR(95%CI)：1.87(1.01-3.46)，P=0.046、心肌梗死HR(95%CI)：2.25(1.19-4.26)，P=0.013是SWI的独立危险因素。
      结论  基于我院人群SWI的独立危险因素为糖尿病、高BMI和心肌梗死。这些因素可能通过破坏伤口愈合过程、损害组织修复和皮肤屏障完整性以及降低对细菌的抵抗力来影响SWI的发生。

     

    Abstract:
      Background  Median sternotomy is a conventional approach for cardiac surgery, and patients undergoing this approach may develop sternal wound infection (SWI), which may bring heavy economic pressure and great psychological burden and pain to patients.
      Objective  To explore the independent risk factors for SWI, so as to lower its incidence and take preventive measures.
      Methods  A retrospective analysis was conducted on patients who underwent open heart surgery through the median sternotomy approach at Chinese PLA General Hospital from January 2011 to January 2021. Cases of SWI were screened and a 1:4 propensity matching was performed. Characteristic variables were screened by univariate Cox analysis and LASSO regression. After considering expert opinions, appropriate variables were selected for multivariate Cox regression analysis.
      Results  Of the 5 471 cases, 61 cases developed SWI within 180 days after thoracotomy, with a incidence rate of 1.11%, 44 of whom were SSWI and 17 were DSWI. In the whole cohort of 305 patients, there were 21 males and 40 females in the case group, with a median age of 61 years while in the control group, there were 110 males and 134 females, with a median age of 59 years. Multivariate Cox regression analysis showed that body mass index (HR 95%CI : 1.07 1.00-1.14, P = 0.047), diabetes (HR 95%CI: 1.87 1.01-3.46, P = 0.047), and myocardial infarction (HR 95%CI: 2.25 1.19-4.26, P = 0.010) were independently associated with SWI.
      Conclusion  We find that the independent risk factors for SWI are diabetes, increased body mass index, and myocardial infarction. These factors are thought to influence the development of SWI by disrupting wound healing process, impairing tissue repair and skin barrier integrity, and decreasing resistance to bacteria.

     

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