Študija okužb kirurške rane po sternotomiji pri pacientih s kirurško revaskularizacijo srca : magistrsko delo

Kamenšek, Tina (author), Žibert, Janez (mentor), Trunk, Primož (comentor)

Uvod: Okužbe kirurških ran po srčnih operacijah se v svetu in v Sloveniji kljub antibiotični preventivi še vedno pojavljajo in negativno vplivajo na pacienta ter bremenijo ekonomski zdravstveni sistem. Koronarna bolezen je eden najpogostejših vzrokov smrti v svetu, ki se jo zdravi tudi z metodo kirurške revaskularizacije srca. Uporaba negativnega tlaka je metoda, ki se v kirurgiji že nekaj časa izvaja za zdravljenje okuženih kirurških ran, vse bolj pa se jo izvaja tudi kot preventivo kirurških okužb na zašitih kirurških ranah. Namen: Želeli smo raziskati in predstaviti vpliv posameznih faktorjev na razvoj okužbe kirurške rane po sternotomiji po posegu kirurške revaskularizacije srca ter preučiti vpliv uporabe negativnega tlaka pri preprečevanju okužbe kirurške rane po sternotomiji. Metode dela: Za potrebe empiričnega dela so bili analizirani primarni in sekundarni viri. Izvedena je bila retrospektivna študija 592 pacientov, pri katerih smo preverjali in z metodo logistične regresije napovedovali vpliv faktorjev na okužbo kirurške rane po sternotomiji po posegu kirurške revaskularizacije srca. V sklopu večje prospektivne študije je bila izvedena pilotna študija 53 pacientov, pri katerih smo preverjali vpliv uporabe negativnega tlaka na preprečevanje razvoja okužbe kirurške rane po sternotomiji po posegu kirurške revaskularizacije srca. Rezultati: Od opazovanih faktorjev sta se kot statistično značilno pomembna za razvoj okužbe kirurške rane po sternotomiji pokazala indeks telesne mase (p = 0,043) in trajanje operacije (p = 0,007). Smrtnost in pojav infekta nista bila statistično značilno povezana (p = 0,211). Pri pilotni študiji sta si bila vzorca med seboj statistično značilno podobna, razlikovala sta se samo v prisotnosti diabetesa (p = 0,034), rezultati preliminarne pilotne študije pa nakazujejo na to, da naj vrsta oskrbe kirurške rane ne bi vplivala na pogostost pojava okužbe kirurške rane po sternotomiji (p = 0,745). Razprava in sklep: Pri pacientih, ki imajo opravljeno večje število obvodov in pri katerih operacija traja dalj časa, ter pacientih z višjim indeksom telesne mase bi bilo smiselno preventivno uporabljati obliže z negativnim tlakom za kirurško rano, saj bi oskrba rane v primerjavi z ekonomskim bremenom ob pojavu okužbe predstavljala minimalen strošek.

• Language: Slovenian
• Keywords: okužba kirurške rane, terapija z negativnim tlakom, rizični dejavniki, glikemična kontrola, kirurška revaskularizacija srca
• Work type: Master's thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2017
• PID: 20.500.12556/RUL-94454
• COBISS.SI-ID: 5302635
• Publication date in RUL: 27.08.2017

Secondary language

• Language: English
• Title: Study of surgical wound infections after sternotomy at patients with surgical revascularization of the heart : master's degree dissertation

Abstract

Introduction: Sternal wound infections after cardiac surgery still occur worldwide and in Slovenia, despite the preventive use of antibiotics, and negatively affect the patient outcome and also the economics of the health system. Coronary artery disease is among the most common causes of death in the world, and it is commonly treated with the method of surgical revascularization of the heart. The method of negative pressure wound therapy is used in surgery for a while, mostly for the treatment of infected surgical wounds. Increasingly the negative pressure is used as a prevention of closed surgical wound infections. Purpose: We wanted to explore and represent the effect of different risk factors on development of surgical wound infections after sternotomy after surgical revascularization of the heart, and to examine the effect of the negative pressure method on prevention of closed sternal surgical wound infections. Methods: Primary and secondary sources were analyzed for the empirical part. Retrospective study was performed on 592 patient, in which we have explored and with the method of logistic regression predicted the influence of factors on the development of wound infection after sternotomy after surgical revascularization of the heart. In the context of larger prospective study the pilot study on 53 patients was done, in which we examined the influence of negative wound pressure method on prevention of development of wound infection after sternotomy after surgical revascularization of the heart. Results: From all observed factors, body mass index (p = 0,043) and the operative time (p = 0,007) statistically significantly influenced on development of sternal surgical infections. Mortality and the occurrence of infection were not significantly associated (p = 0,211). In a pilot study, the two groups were almost statistically similar, the only difference between groups was in the presence of diabetes (p = 0,034). Results of a preliminary pilot study suggest that the type of surgical wound care does not affect the occurrence of wound infection after sternotomy (p = 0,745). Discussion and conclusion: In patients with higher number of grafts and consequently longer operative time and patients with increased body mass index, it would be reasonable to use a dressing with negative pressure for the prevention of surgical wound infection. The cost of negative pressure dressing would be minimal compared to the economic burden of the wound infections after sternotomy.

• Keywords: sternal wound infection, negative pressure wound therapy, risk factors, glycemic control, surgical revascularization of the heart