溃疡油联合纳米银治疗心脏术后伤口不愈合4例报道

摘要
图/表
参考文献(27)
相关文章 (1)

全文: PDF (871 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要心脏术后胸壁和下肢血管供区伤口感染、裂开、血肿、延迟愈合等并发症发生率高，其治疗方法局限、伤口愈合难度大，是临床面临的棘手问题。将溃疡油联合纳米银用于治疗心脏术后伤口不愈合，发现其具有加速伤口愈合的作用。本文报道2018—2020年于中日友好医院住院治疗的4例典型病例（男3例，女1例），均行开胸心脏手术，术后1个月伤口仍未愈合。主要表现为伤口裂开、创缘坏死、硬痂形成、伤口内组织失活、胸骨开裂、脓液积聚。2例伴有鲍曼不动杆菌定植，3例存在胸壁伤口不愈合，2例存在下肢血管供区伤口不愈合，1例胸骨裂开且内固定物松动。伤口治疗均采用清创术后溃疡油联合纳米银外敷，隔日换药1次。4例伤口分别于65、45、40、65 d后愈合，平均愈合时间为53.75±13.15 d。溃疡油联合纳米银可加速心脏术后延迟愈合伤口的愈合进程，其主要适用于胸骨表面浅表伤口和El Oakley Ⅰ型和Ⅱa型伤口、下肢血管供区伤口。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	刘守尧1 袁泉1 赵芮崧2 赵其超3 夏仲元1

关键词 ：心脏术后, 伤口并发症, 溃疡油, 纳米银, 伤口不愈合

Abstract：The complications of postcardiac surgery such as wound infection, cracking, hematoma and delayed union, etc. The chest wall and lower limb blood vessel donor sites have high incidence rates, limited therapeutic methods and high difficulty in wound healing, and they are clinical problematic issues. Ulcer oil and nano-silver were used to treat the wound cracking of postcardiac surgery and found that the combination could accelerate the wound healing. The four clinical cases reported in this paper had been treated in hospitalization of China-Japan Friendship Hospital during the period from 2018 to 2020 (three males and one female), who had been performed open chest surgery, but their wounds had not been healed for one month after the surgery. The main expressions were wound dehiscence, wound edge necrosis, formation of hard scab, inactivation of wound internal tissue, sternum cracking and fester accumulation. Two cases were also with Acinetobacter baumanii planting; three cases were with the non-healing wounds of chest wall, two cases were with non-healing wounds of lower limb blood vessel donor site, one case was with sternum cracking of sternum, and the internal fixator was loosen. The wound was treated with the external application of ulcer oil combined with nano-silver after debridement surgery, and the dressings were changed every other day. The four cases’ wounds were healed on 65, 45, 40 and 65 days later, with the average healing time of 53.75 days. The combination of ulcer Oil and nano-silver could accelerate the healing progress of the delayed healing of wounds caused by postcardiac surgery. It is mainly applicable for superficial wounds of sternum surface and wounds of El Oakley Ⅰ Type and Ⅱa Type and wounds in lower limbs blood vessel donor site.

Key words： Postcardiac surgery Wound complication Ulcer oil Nano-silver Non-healing wound

基金资助:北京市中医药科技发展资金项目（JJ-2020-89）；
中日友好医院院级科研基金项目（2019-1-QN-55）。

通讯作者: 夏仲元（1961-），女，博士，主任医师，博士生导师，主要从事甲状腺、乳腺疾病、慢性创面的中西医结合治疗工作。

作者简介: 刘守尧（1985-），男，博士，主要从事慢性创面的中西医结合治疗工作。

引用本文:

刘守尧1 袁泉1 赵芮崧2 赵其超3 夏仲元1. 溃疡油联合纳米银治疗心脏术后伤口不愈合4例报道[J]. 中国医药导报, 2021, 18(20): 180-183,192.
LIU Shouyao1 YUAN Quan1 ZHAO Ruisong2 ZHAO Qichao3 XIA Zhongyuan1. A report on four cases with non-healing wounds caused by postcardiac surgery treated by the combination of ulcer oil and nano-silver. 中国医药导报, 2021, 18(20): 180-183,192.

链接本文:

https://www.yiyaodaobao.com.cn/CN/ 或 https://www.yiyaodaobao.com.cn/CN/Y2021/V18/I20/180

[1] Allie DE，Hebert CJ，Lirtzman MD，et al. Novel Treatment Strategy for Leg and Sternal Wound Complications After Coronary Artery Bypass Graft Surgery：Bioengineered Apligraf [J]. Ann Thorac Surg，2004，78（2）：673-678.
[2] Damavandi DS，Javan M，Moshashaei H，et al. Microbial Contamination after Cardiac Surgery in a Hospital Cardiac Surgery Ward [J]. J Med Life，2020，13（3）：342-348.
[3] Au WK，Chiu SW，Sun MP，et al. Improved Leg Wound Healing with Endoscopic Saphenous Vein Harvest in Coronary Artery Bypass Graft Surgery：A Prospective Randomized Study in Asian Population [J]. J Card Surg，2008， 23（6）：633-637.
[4] Schols RM，Lauwers TM，Geskes GG，et al. Deep sternal wound infection after open heart surgery：current treatment insights. A retrospective study of 36 cases [J]. Eur J Plast Surg，2011，34（6）：487-492.
[5] Zuckermann A，Barten MJ. Surgical wound complications after heart transplantation [J]. Transpl Int，2011，24（7）：627-636.
[6] Tashnizi MA，Alamdari DH，Khayami ME，et al. Treatment of non-healing sternum wound after open-heart surgery with allogenic platelet-rich plasma and fibrin glue-preliminary outcomes [J]. Indian J Plast Surg，2013，46（3）：538-542.
[7] Filsoufi F，Rahmanian PB，Castillo JG，et al. Incidence，treatment strategies and outcome of deep sternal wound infection after orthotopic heart transplantation [J]. J Heart Lung Transplant，2007，26（11）：1084-1090.
[8] Phoon PHY，Hwang NC. Deep Sternal Wound Infection：Diagnosis，Treatment and Prevention [J]. J Cardiothorac Vasc Anesth，2020，34（6）：1602-1613.
[9] Smárason NV，Sigurjónsson H，Hreinsson K，et al. Reoperation for bleeding following open heart surgery in Iceland [J]. Laeknabladid，2009，95（9）：567-573.
[10] de Jesus LE，Martins AB，Oliveira PB，et al. Negative pressure wound therapy in pediatric surgery：How and when to use [J]. J Pediatr Surg，2018，53（4）：585-591.
[11] 林野，李守军.封闭式持续负压吸引治疗小儿心脏外科手术后累及胸骨的深部切口感染[J].临床小儿外科杂志，2020，19（9）：806-809.
[12] 刘文，夏先学，王东生.富血小板血浆在胸部正中切口术后创面难愈并发胸骨骨髓炎治疗中的应用[J].山东医药，2018，58（38）：72-74.
[13] 卫裴，罗鹏飞，夏照帆.皮肤替代模式的研究现状及发展前景[J].中华损伤与修复杂志：电子版，2019，14（3）：161-165.
[14] 张熠杰，陈刚，官浩，等.胸骨切开术后裂开及组织瓣移植修复研究进展[J].中华烧伤杂志，2019，35（12）：879-883.
[15] 代永静，李红菊，柴军萍，等.低能量放散状冲击波治疗法结合湿性疗法在创伤性骨或肌腱外露伤口中的应用效果[J].华西医学，2015，30（10）：1815-1817.
[16] Lee JC，Kandula S，Sherber NS. Beyond wet-to-dry：a rational approach to treating chronic wounds [J]. Eplasty，2009，9（14）：131-137.
[17] Kanji S，Das H. Advances of Stem Cell Therapeutics in Cutaneous Wound Healing and Regeneration [J]. Mediators Inflamm，2017，（2017）：1-14.
[18] Xiong Y，Chen L，Fan L，et al. Free Total Rhubarb Anthraquinones Protect Intestinal Injury via Regulation of the Intestinal Immune Response in a Rat Model of Severe Acute Pancreatitis [J]. Front Pharmacol，2018，9（75）：1-13.
[19] Gu J，Su S，Guo J，et al. Anti-inflammatory and anti-apoptotic effects of the combination of Ligusticum chuanxiong and Radix Paeoniae against focal cerebral ischaemia via TLR4/MyD88/MAPK/NF-κB signalling pathway in MCAO rats [J]. J Pharm Pharmacol，2018，70（2）：268-277.
[20] Song L，Pei L，Yao S，et al. NLRP3 Inflammasome in Neurological Diseases，from Functions to Therapies [J]. Front Cell Neurosci，2017，9（11）：1-17.
[21] Wu X，Zhang F，Xiong X，et al. Tetramethylpyrazine reduces inflammation in liver fibrosis and inhibits inflammatory cytokine expression in hepatic stellate cells by modulating NLRP3 inflammasome pathway [J]. IUBMB Life，2015，67（4）：312-321.
[22] Shen C，Zhang Z，Xie T，et al. Rhein Suppresses Lung Inflammatory Injury Induced by Human Respiratory Syncytial Virus Through Inhibiting NLRP3 Inflammasome Activation via NF-κB Pathway in Mice [J]. Front Pharmacol，2020，10：1600.
[23] Gudbjartsson T，Jeppsson A. Wound infections following open heart surgery-review [J]. Laeknabladid，2019，105（4）：177-182.
[24] Husain S，Camargo JF. Invasive Aspergillosis in solid-organ transplant recipients：Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice [J]. Clin Transplant，2019，33（9）：e13544.
[25] 胡烈海，朱新根，余双，等.纳米银抗菌应用的研究进展[J].中国抗生素杂志，2020，45（8）：745-750.
[26] 刘冬，王文璋，蔡爱兵，等.心脏手术后深部胸骨切口感染修复与重建189例临床分析[J].中华外科杂志，2015， 53（3）：193-196.
[27] El Oakley RM，Wright JE. Postoperative mediastinitis：classification and management. [J]. Ann Thorac Surg，1996，61（3）：1030-1036.