在深胸部伤口感染中感染的治疗-单一中心队列研究
Stephan Raab1, Evaldas Girdauskas1, Sebastian Reindl1
1Clinic for Cardiothoracic Surgery, University Hospital Augsburg, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
Journal of thoracic disease
|March 12, 2026
概括
通过负压伤口疗法 (NPWT) 实现深胸部伤口感染 (DSWIs) 的无菌性,可以减少并发症. 长期的抗生素治疗对于在伤口关闭之前无法达到无菌性至关重要.
科学领域:
- 心血管外科心血管外科
- 传染性疾病 传染性疾病
- 伤口愈合 治愈 伤口愈合
背景情况:
- 深胸部伤口感染 (DSWIs) 在心脏手术后是一个挑战,复杂的胸壁重建.
- 使用负压伤口治疗 (NPWT),但停止治疗和关闭伤口的最佳时间尚不清楚.
- 关键问题涉及实现不育,抗生素治疗的必要性及其持续时间.
研究的目的:
- 评估在NPWT期间实现微生物无菌性对DSWI结果的影响.
- 为了比较短期与长期抗生素治疗在DSWI管理中的有效性.
- 确定在DSWI中NPWT停止和伤口关闭的最佳策略.
主要方法:
- 对心脏手术后的DSWI患者 (2014-2020年) 的回顾性分析.
- 收集的数据包括基线特征,NPWT变化,感染持久性和抗生素治疗持续时间 (5天vs6周).
- 基于实现的无菌性和抗生素治疗方案的结果比较.
主要成果:
- 79名患者平均经过10.2次NPWT带更换后获得了无菌性;51名患者在7.4次更换后没有达到无菌性.
- 实现不孕不育与明显较低的感染并发症率有关.
- 与短期治疗 (5天) 相比,长期抗生素治疗 (6周) 导致感染明显减少.
结论:
- 对于DSWI,在NPWT期间优先考虑微生物无菌性,尽管需要更换更多的包装,但减少了整体并发症.
- 如果在伤口关闭之前无法实现不育,建议进行长期的抗生素治疗,特别是在骨髓炎的情况下.
- 这些发现指导了关于NPWT管理和在DSWI治疗中使用抗生素的临床决策.
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