心脏手术中胸骨正中切口胸骨断面使用骨蜡填塞止血-中国循环杂志.PDF

中国循环杂志 2016 年 6 月 第 31 卷 第 6 期（总第 216 期）Chinese Circulation Journal，June，2016，Vol. 31 No.6（Serial No.216） 593 临床研究 心脏手术中胸骨正中切口胸骨断面使用骨蜡填塞止血必要性的探讨 张士举，王小启，闫鹏，李涵，王立清 摘要 目的：分析在心脏手术中，骨蜡用于胸骨正中切口胸骨断面填塞止血的必要性。 方法：连续入选 2011-01 至 2014-12 期间共 445 例患者，其中 210 例患者的胸骨断面使用骨蜡（骨蜡组 ），235 例患者的胸骨断面未使用骨蜡（无骨蜡组 ）。分别比较两组患者的二次开胸止血情况以及 12 小时、24 小时及总的引 流量，关胸时间和输血率。 结果：骨蜡组和无骨蜡组分别有 2 例和 1 例患者二次开胸止血，但与骨髓腔出血无关。两组患者的 12 小时、24 小时及总引流量分别为（451±240）ml 和 （483±238）ml、（615±304）ml 和（639±285）ml、（842±467）ml 和（842±364） ml（P 均 0.05）。骨蜡组和无骨蜡组关胸时间分别为（68.0±23.0）min 和（66.0±19.0）min（P 0.05）。骨蜡组和无骨 蜡组总输血率分别是 21% 和 19%（P 0.05）。 结论：胸骨断面骨蜡的使用不会显著减少关胸后的引流量，也不会影响关胸速度。应舍弃骨蜡在胸骨断面止血 中的应用。 关键词 心脏外科手术；胸骨切开术；骨蜡 Necessity of Bone Wax Stanching Bleeding at Sternal Edge in Patients With Cardiac Surgery by Median Sternotomy ZHANG Shi-ju, WANG Xiao-qi, YAN Peng, LI Han, WANG Li-qing. Department of Cardiac Surgery, Cardiovascular Institute and Fu Wai Hospital, CAMS and PUMC, Beijing (100037), China Corresponding Author: WANG Li-qing, Email: wltsmd@ Abstract Objective: To explore the necessity for application of bone wax stanching bleeding at sternal edge in cardiac surgery by median sternotomy. Methods: A total of 445 patients who receive cardiac surgery by the same surgeon performing median sternotomy in our hospital from 2011-01 to 2014-12 were studied. According to application of bone wax stanching bleeding, the patients were divided into 2 groups: Bone wax group, n=210 and Non-bone wax group, n=235. Re-thoracotomy for hemostasis, 12 h, 24 h and total draining volume after the operation and time of closing incision were compared between 2 groups. Results: There were 2 patients and 1 patient received re-thoracotomy for hemostasis in Bone wax group and Non-bone wax group respectively, which was not related to