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中华损伤与修复杂志(电子版) ›› 2020, Vol. 15 ›› Issue (03) : 210 -214. doi: 10.3877/cma.j.issn.1673-9450.2020.03.012

所属专题： 文献；

论著

影响心脏术后早期前胸裂开切口愈合因素的临床分析
侯玉森1, 曹玉珏1,†(), 余斌1, 马彩虹1, 屠海霞1, 赵鹏亮1, 朱海涛1, 郑介飞1   
  1. 1. 100069　北京丰台右安门医院烧伤整形科
  • 收稿日期:2020-02-13 出版日期:2020-06-01
  • 通信作者: 曹玉珏

Clinical analysis of factors influencing the healing of anterior thorax incision in early postoperative cardiac surgery

Yusen Hou1, Yujue Cao1,†(), Bin Yu1, Caihong Ma1, Haixia Tu1, Pengliang Zhao1, Haitao Zhu1, Jiefei Zheng1   

  1. 1. Department of Burns and Plastic Surgery, Beijing Fengtai You Anmen Hospital, Beijing 100069, China
  • Received:2020-02-13 Published:2020-06-01
  • Corresponding author: Yujue Cao
  • About author:
    Corresponding author: Cao Yujue, Email:
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侯玉森, 曹玉珏, 余斌, 马彩虹, 屠海霞, 赵鹏亮, 朱海涛, 郑介飞. 影响心脏术后早期前胸裂开切口愈合因素的临床分析[J]. 中华损伤与修复杂志(电子版), 2020, 15(03): 210-214.

Yusen Hou, Yujue Cao, Bin Yu, Caihong Ma, Haixia Tu, Pengliang Zhao, Haitao Zhu, Jiefei Zheng. Clinical analysis of factors influencing the healing of anterior thorax incision in early postoperative cardiac surgery[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2020, 15(03): 210-214.

目的

探讨年龄、糖尿病、感染、负压封闭引流技术治疗因素对心脏术后早期前胸裂开切口愈合的影响。

方法

选择2017年7月至2019年7月北京丰台右安门医院烧伤整形科收治的261例心脏术后早期前胸切口裂开不愈患者。依据年龄、合并糖尿病与否、感染与否、是否采用负压封闭引流技术治疗4个因素，将患者分别分为2组。低龄组(≤56岁)109例，高龄组(>56岁)152例；糖尿病组111例，非糖尿病组150例；感染组146例，非感染组115例；负压封闭引流组119例，非负压封闭引流组142例。通过网络或门诊随访患者胸骨切口皮肤有无红肿及破溃。评价比较各2组患者术后切口愈合时间及住院时间。数据比较采用t检验。

结果

随访3～6个月患者胸骨切口皮肤均无红肿及破溃。低龄组患者切口愈合时间、住院时间分别为(12.7±3.6)、(24.9±9.5) d，与高龄组[(17.8±5.4)、(30.7±14.2) d]比较，差异均有统计学意义(t＝9.359、13.861，P值均小于0.05)。糖尿病组患者切口愈合时间、住院时间分别为(15.4±4.6)、(29.1±12.4) d，与非糖尿病组[(14.7±3.8)、(27.7±9.1) d]比较，差异均无统计学意义(t＝0.162、0.031，P值均大于0.05)。感染组患者切口愈合时间、住院时间分别为(15.5±4.3)、(30.6±14.1) d，与非感染组[(14.3±4.2)、(29.6±12.7) d]比较，差异均无统计学意义(t＝0.775、0.648，P值均大于0.05)。负压封闭引流组切口愈合时间、住院时间分别为(11.6±3.7)、(32.4±13.2)d，与非负压封闭引流组[(15.7±4.2)、(23.9±10.7) d]比较，差异均有统计学意义(t＝6.831、3.957，P值均小于0.05)。

结论

糖尿病、感染等因素并不影响心脏术后早期前胸裂开切口的愈合时间，负压封闭引流治疗可缩短术后切口愈合时间，年龄可作为判断切口愈合时间长短的一个重要指标。

关键词: 外科伤口裂开, 伤口愈合, 负压伤口疗法, 年龄因素, 糖尿病, 感染, 心脏手术
Objective

To investigate the influence of age, diabetes, infection and negative pressure treatment on the healing of anterior thorax incision in early postoperative cardiac surgery.

Methods

Two hundred and sixty one patients with early postoperative dehiscence of anterior thorax incision were selected from July 2017 to July 2019 in the Department of Burns and Plastic Surgery, Beijing Fengtai You Anmen Hospital. Patients were divided into 2 groups respectively according to different factors of age, diabetes or not, infection or not, whether to use negative pressure closure drainage treatment. There were 109 cases in the younger group(≤56 years old) and 152 cases in the older group(>56 years old). There were 111 cases in the diabetic group and 150 cases in the non-diabetic group. There were 146 cases in the infected group and 115 cases in the non-infected group. There were 119 cases in the negative pressure closure drainage group and 142 cases in the non-negative pressure closure drainage group. The patients were followed up online or in the outpatient for redness, swelling and rupture of the sternal incision skin.Incision healing time and hospital stay of two groups of patients were evaluated and compared. The data were processed with t test.

Results

No redness, swelling or ulceration of the sternal incision skin was observed in the patients after 3-6 months of follow-up. The incision healing time and the length of hospital stay in the younger group were (12.7±3.6), (24.9±9.5) d respectively, compared with the older group [(17.8±5.4), (30.7±14.2) d], the differences were statistically significant (t=9.359, 13.861; with P values below 0.05). The incision healing time and the length of hospital stay in the diabetic group were (15.4±4.6), (29.1±12.4) d respectively, compared with the non-diabetic group [(14.7±3.8), (27.7±9.1) d], the differences were not statistically significant (t=0.162, 0.031; with P values above 0.05). The incision healing time and the length of hospital stay in infected group were (15.5±4.3), (30.6±14.1) d respectively, compared with the non-infected group [(14.3±4.2), (29.6±12.7) d], the differences were not statistically significant (t=0.775, 0.648; with P values above 0.05). The incision healing time and the length of hospital stay in the negative pressure closure drainage group were (11.6±3.7), (32.4±13.2) d respectively, compared with the non-negative pressure closure drainage group [(15.7±4.2), (23.9±10.7) d], the differences were statistically significant (t=6.831, 3.957; with P values below 0.05).

Conclusions

Factors such as diabetes and infection do not affect the healing time of the incision in the early postoperative cardiac surgery. Negative pressure closure drainage treatment can shorten the healing time of the incision incision, and age can be an important indicator of the incision healing time.

Key words: Surgical wound dehiscence, Wound healing, Negative-pressure wound therapy, Age factors, Diabetes mellitus, Infection, Heart surgery
表1 依据年龄分组的2组患者的基本资料比较
组别 例数 性别(例) 冠状动脉搭桥术[例(%)] 心脏瓣膜术[例(%)] 其他心脏手术[例(%)]
男 女
低龄组 109 80 29 68(62.4) 23(21.1) 18(16.5)
高龄组 152 106 46 96(63.2) 29(19.1) 27(17.8)
χ2值 ? 0.415 0.016 0.163 0.069
P值 ? 0.520 0.899 0.687 0.792
表2 依据是否合并糖尿病分组的2组患者的基本资料比较
组别 例数 性别(例) 冠状动脉搭桥术[例(%)] 心脏瓣膜术[例(%)] 其他心脏手术[例(%)]
男 女
非糖尿病组 150 109 41 99(66.0) 27(18.0) 24(16.0)
糖尿病组 111 77 34 65(58.6) 25(22.5) 21(18.9)
χ2值 ? 0.339 1.513 0.818 0.318
P值 ? 0.561 0.219 0.366 0.537
表3 依据是否感染分组的2组患者的基本资料比较
组别 例数 性别(例) 冠状动脉搭桥术[例(%)] 心脏瓣膜术[例(%)] 其他心脏手术[例(%)]
男 女
非感染组 115 84 31 71(61.7) 21(18.3) 19(16.5)
感染组 146 102 44 93(63.7) 31(21.2) 26(17.8)
χ2值 ? 0.318 0.106 0.356 0.075
P值 ? 0.573 0.745 0.551 0.792
表4 依据是否采用负压封闭引流技术治疗分组的2组患者的基本资料比较
组别 例数 性别(例) 冠状动脉搭桥术[例(%)] 心脏瓣膜术[例(%)] 其他心脏手术[例(%)]
男 女
非负压封闭引流组 142 103 39 94(66.2) 28(19.7) 20(14.1)
负压封闭引流组 119 83 36 70(58.8) 24(20.2) 25(21.0)
χ2值 ? 0.246 1.507 0.008 2.175
P值 ? 0.623 0.220 0.928 0.140
表5 依据年龄分组的2组患者的切口愈合时间及住院时间比较(d, ±s)
组别 例数 切口愈合时间 住院时间
低龄组 109 12.7±3.6 24.9±9.5
高龄组 152 17.8±5.4 30.7±14.2
t值 ? 9.359 13.861
P值 ? 0.035 <0.05
表6 依据是否合并糖尿病分组的2组患者的切口愈合时间及住院时间比较(d, ±s)
组别 例数 切口愈合时间 住院时间
非糖尿病组 150 14.7±3.8 27.7±9.1
糖尿病组 111 15.4±4.6 29.1±12.4
t值 ? 0.162 0.031
P值 ? 0.519 0.863
表7 依据是否合并感染分组的2组患者的切口愈合时间及住院时间比较(d, ±s)
组别 例数 切口愈合时间 住院时间
非感染组 115 14.3±4.2 29.6±12.7
感染组 146 15.5±4.3 30.6±14.1
t值 ? 0.775 0.648
P值 ? 0.570 0.424
表8 依据是否采用负压封闭引流技术治疗分组的2组患者的切口愈合时间及住院时间比较(d, ±s)
组别 例数 切口愈合时间 住院时间
非负压封闭引流组 142 15.7±4.2 23.9±10.7
负压封闭引流组 119 11.6±3.7 32.4±13.2
t值 ? 6.831 3.957
P值 ? 0.033 0.048
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