HÜSEYİN ŞAŞKIN, ÇAĞRI DÜZYOL, Kazım Serhan ÖZCAN, Hüseyin MAÇİKA, Mustafa İDİZ

AçıkKalpCerrahisi SonrasıGelişenDerinSternal Enfeksiyonların TedavisindeVakumYardımlıKapamaYöntemininEtkinliği

GİRİŞ ve AMAÇ: Bu çalışma, kardiyak cerrahi sonrası gelişen derin sternal yara enfeksiyonlarında konvansiyonel tedavi yöntemleriyle vakum yardımlı kapama tedavi yönteminin uygulandığı hastaların ölüm, reenfeksiyon ve hastanede kalış sürelerini karşılaştırmak için tasarlanmıştır. YÖNTEM ve GEREÇLER: Çalışmaya Kasım 2006-Haziran 2014 tarihleri arasında aynı merkezde açık kalp cerrahisi sonrası derin sternal yara enfeksiyon tanısıyla tedavi uygulanan 72 hasta dâhil edildi. Hasta verileri retrospektif olarak incelendi. Konvansiyonel yara bakımı ve pansuman yöntemleriyle tedavi uygulanan hastalar Grup 1(n=38), vakum yardımlı kapama yöntemiyle tedavi uygulanan hastalar ise Grup 2(n=34) olarak sınıflandırıldı. BULGULAR: Hastaların 25'i kadın olup yaş ortalaması 65,3±7,8 yıldı. Tedavinin 7.gününde bakılan ortalama C-reaktif protein(p=0.02), ortalama lökosit sayısı(p=0.01) ve ortalama eritrosit sedimantasyon hızı(p=0.005) değerleri açısından gruplar arasında anlamlı fark mevcuttu. Tedavinin 10.günü alınan mediastinal veya sternal yara akıntı kültüründe Grup 1'de 26 hastada(68,4%), Grup 2'de ise 5 hastada(14,7%) mikroorganizma üremesi mevcuttu(p=0.0001). Doksan günlük mortalite Grup 1'de gelişmezken Grup 2'de ise 6 hasta(%15,8)'da gelişti(p=0.03). Sağ kalan hastaların hastanede kalış süreleri Grup 1'de ortalama 23,3±5,5 gün iken Grup 2'de ise 17,3±3,4 gündü(p=0.0001). TARTIŞMA ve SONUÇ: Açık kalp cerrahisi sonrası gelişen derin sternal yara enfeksiyonların tedavisinde vakum yardımlı kapama yöntemi konvansiyonel tedavi yöntemlerine göre yara iyileşmesini hızlandıran, hastanede kalış süresini kısaltan ve yara yerindeki mikroorganizmaların daha erken eradikasyonunu sağlayan güvenli ve etkili bir yöntemdir.

TheEfficiencyofVacuumAssistedClosureMethodforTreatmentofDeep SternalInfectionsFollowingOpenCardiacSurgery

INTRODUCTION: In this study, we aimed to compare the conventional treatment methods with vacuum assisted closure treatment technique for mortality, re-infection and duration of hospitalization in patients who had deep sternal wound infection after cardiac surgery. METHODS: Seventy two patients who had deep sternal infection after open heart surgery between November 2006-June 2014 were enrolled in the study. The data were collected retrospectively. The patients who were treated with conventional wound care were enrolled in group 1(n=38), the patients who were treated with vacuum assisted closure were enrolled in group 2 (n=34). RESULTS: Twenty five of the patients were female and the mean age of the patients were 65,3±7,8 years. The mean values of C-reactive protein(p=0.02), leukocyte counts(p=0.01) and erythrocyte sedimentation rate (p=0.005) were significantly different between the groups. The incubation of sternal and mediastinal swap at 10 days were positive in 26 patients in group 1(68,4%), and positive in 5 patients in group 2(14,7%)(p=0.0001). The 90-days mortality; no mortality was observed in group 1, and 6 of patients(%15,8) died in group 2 (p=0.03). The duration of hospitalization in survived patients were 23,3±5,5 days in group 1 and were 17,3±3,4 days in group 2 (p=0.0001). DISCUSSION AND CONCLUSION: The patients who were treated with vacuum assisted closure when compared to conventional wound care, for deep sternal wound infection after cardiac surgery, were associated with shortened hospital stay, accelerate in wound healing and eradication of microorganisms.

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