Open chest and delayed sternal closure after cardiac surgery
Open chest and delayed sternal closure after cardiac surgery
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DOI：
10.1016/s1010-7940(96)80087-x
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发表时间：
1996-05-01
影响因子：
3.4
通讯作者：
Schmuziger, M
中科院分区：
文献类型：
--
作者：
Christenson, JT;Simonet, F;Schmuziger, M
目的：开胸（OC）和随后的延迟胸骨关闭（DSC）已被描述为一个有用的方法在治疗严重受损的心脏后，心脏surgery.Methods：延长开胸被用于142至3373成人心脏手术（4.2%）之间的1987年1月和1993年12月。适应症为：血流动力学损害（121），顽固性出血（9）和心律失常（12）。142例患者中有123例进行了延迟胸骨闭合，平均时间为2.0 ± 1.4天（范围0.5-8天）。心脏联合手术后开胸和DSC的使用比例更高（28/293，9.6%）比单纯冠状动脉旁路移植术（CABG）后（108/2891，3.7%）或阀门操作结果：123例DSC患者中有97例（78.9%）存活，并在闭合后平均8.6 +/- 4.2天出院。45例患者死亡：DSC前19例，该方法后26例。死亡率与OC适应症相关：当适应症为低心输出量时，死亡率为38.6%，闭合时血流动力学崩溃为0%，弥漫性出血为33.3%，心律失常为27.3%。在没有主动脉内球囊反搏支持的患者中，延迟胸骨闭合更有可能成功（死亡率4/25，16.0% vs 35/76，46.3%，P
Objectives: Open chest (OC) and subsequent delayed sternal closure (DSC) has been described as a useful method in the treatment of the severely impaired heart after cardiac surgery.Methods: Prolonged open chest was used in 142 to 3373 adult cardiac operations (4.2%) between January 1987 and December 1993. The indications were: hemodynamic compromise (121), intractable bleeding (9) and arrhythmias (12). Delayed sternal closure was carried out in 123 of 142 patients at a mean of 2.0 +/- 1.4 days (range 0.5-8 days). Open chest and DSC were used proportionally more frequently after combined cardiac surgery (28/293, 9.6%) than after coronary artery bypass grafting (CABG) alone (108/2891, 3.7%) or valve operation (6/230, 2.6%).Results: Ninety-seven of the 123 who had DSC (78.9%) survived and were discharged an average of 8.6 +/- 4.2 days after closure. Fourty-five patients died: 19 before DSC and 26 after this method. Mortality was related to indications for OC: when the indication was low cardiac output the mortality was 38.6%, for hemodynamic collapse on closure 0%, diffuse bleeding 33.3% and arrhythmias 27.3%. Delayed sternal closure in patients without intra aortic balloon pump support was more likely to be successful (mortality rate 4/25, 16.0% versus 35/76, 46.3%, P