胸骨深部伤口感染引发败血症患者的临床分析:一项回顾性队列研究

Bin Song, Zhentian Cui, Hongyan Ju, Yue Sun, Dandan Liu, Guang-Yu Li
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摘要

本研究旨在总结胸骨正中切开术后胸骨深部伤口感染诱发败血症患者的临床特征,改善感染相关败血症的治疗效果。 该研究对重症医学科收治的21例胸骨正中切开术后胸骨深部伤口感染诱发败血症患者进行了回顾性队列研究。研究总结了患者的临床表现、实验室检查结果、感染控制、器官和营养支持情况,并获得了随访数据。 胸骨深部伤口感染引发败血症的主要症状包括呼吸困难、高烧、寒战和意识状态改变。实验室检查结果显示炎症指标升高,氧合指数下降。分别有 8 名和 4 名患者出现肾功能和肝功能损伤;分别有 18 名和 12 名患者的 D-二聚体和 N 端 Pro B 型钠尿肽水平升高。在伤口分泌物细菌检测呈阳性的 8 名患者中,分别有 6 名和 2 名患者感染了鲍曼不动杆菌和金黄色葡萄球菌。在血液培养细菌检测呈阳性的 6 名患者中,有一人感染了白色念珠菌。15 名患者接受了呼吸机辅助通气治疗,2 名患者接受了肾脏替代治疗。在所有 21 名患者中,17 人治愈,2 人死亡,2 人出院。 由胸骨深部伤口感染引起的中度胸骨切开术后败血症通常是由原有疾病引起的。最突出的临床表现是呼吸困难,有时伴有器官功能损害。预防感染、适当的营养支持和维持健康的器官功能是成功治疗的基石。
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Clinical analysis of patients with deep sternal wound infection-induced sepsis: a retrospective cohort study
This study aimed to summarize the clinical characteristics of patients with deep sternal wound infection-induced sepsis after median sternotomy and improve the treatment outcomes of infection-related sepsis. A retrospective cohort study was conducted on 21 patients with deep sternal wound infection-induced sepsis after median sternotomy who were admitted to the Department of Critical Care. The clinical manifestations, laboratory test results, infection control, and organ and nutritional support of the patients were summarized, and the follow-up data were obtained. The primary symptoms of deep sternal wound infection-induced sepsis included dyspnea, high fever, chills, and altered state of consciousness. Laboratory test results revealed increased inflammatory markers and decreased oxygenation index. Renal and liver function injury were observed in 8 and 4 patients, respectively; 18 and 12 patients demonstrated elevated D-dimer and N-terminal Pro B type natriuretic peptide levels, respectively. Of the 8 patients whose wound secretions tested positive for bacteria, Acinetobacter baumannii and Staphylococcus aureus infections were present in 6 and 2 patients, respectively. One of the 6 patients whose blood cultures tested positive for bacteria demonstrated Candida albicans infection. Fifteen patients received ventilator-assisted ventilation and 2 patients received renal replacement therapy. Of all the 21 patients, 17 were cured, 2 died, and 2 were discharged. Postmedian sternotomy sepsis attributed to a deep sternal wound infection usually results from a preexisting condition. The most prominent clinical manifestation is dyspnea, which is sometimes accompanied by the impairment of organ function. Infection prevention, proper nutrition support, and maintenance of healthy organ function are the cornerstones for successful treatment outcomes.
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