Journal of Chest Surgery

  • 제30권12호
  • /
  • Pages.1167-1174
  • /
  • 1997
  • /
  • 2765-1606(pISSN)
  • /
  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
권호 표지

소아에서 개심술후 정중흉골절개의 지연흉골폐쇄에 의한 심장압박 방지효과

Cardiac Decompressing Effect by Delayed Sternal Closure Following Open Heart Surgery in Children

  • 김경환 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 서경필 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실)
  • 발행 : 1997.12.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

저자들은 1991년부터 1996년까지 5년간 지연 흉골 폐쇄를 시행한 20명의 환자를 분석하고 추적 조사 하였다. 남녀비는 11:9였고 평균연령은 6.4개월(범위 7일-5년)이었다. 적응증으로는 개심술후 심근부종에 기인한장치한 불안정한 혈역학적 상태로 인한 것이 15례로 가장 많았고, 심폐기 이탈 불가로 심실 보조 장치를 경우에서가 3례, 폐동맥 밴딩술 후 저산소증으로 인한 것이 2례 등이었다. 흉골 봉합은 술후 평균 102시간(범위 4-213시간)에 이루어졌으며 시행 후 중심 정맥압의 유의한 상승이 관찰되었다. 종격 동염, 환부 감염 등은 없었으며 2례에서 패혈증이 관찰되었다. 5명이 사망하였고 생존환자 15명중 2명 이 술후 추적관찰 기간 중 사망하였다. 누적 생존률은 1년과 2년에서 각각 65.0%였다. 지연 흉골 봉합 은 혈역학적으로 불안정한 심장을 감압하는 좋은 방법이며 성공적인 결과를 얻기 위해서는 적응증에 대한 신중한 고려가 선행되어야 한다고 생각된다.

We retrospectively reviewed a series of 20 patients treated with delayed sternal closure during a 5-year period from 1991 to 1996. Of the 2675 patients with cardiovascular su gery 20 underwent this procedure. Male and female ratio was 11:9, mean age was 6.4 months(range 7 days to 5 years). The indications included unstable hemodynamic profiles after open heart surgery due to myocardial edema and poor lung compliance(15), necessity of mechanical ventricular assist device due to weaning failure(3), and hypoxia after PAB(2). Sternum was closed at a mean interval of 102(range 4 to 213) hours after operation. During delayed sternal closure, central venous pressure was elevated(p<0.05). Mediastinitis and other wound problems did not occur. Sepsis developed in 2 patients and microorganism was confirmed in one of the two patients. Five patients died(mortality 25%). And two of 15 discharged patients died during follow-up period. Cumulative survival rate was 65.0% at 12 months and also 65.0% at 24 months.(Standard error was 10.7%) Delayed sternal closure Is considered to be a good method to decompress the hemodynamically compromised heart. Without that, it is not f asible to come off bypass or to decompress the heart. Of course. careful selection of the indication is imperative.

키워드

참고문헌

  1. Ann Thorac Surg v.58 Cardiac decompression after operation for congenital heart disease in infancy Elami A;Permut LC;Laks H;Drinkwater Jr DC;Sebastian JL
  2. Ann Thorac Surg v.51 Delayed sternal closure for life-threatening complications in cardiac operation: an update Mestres CA;Pomar JL;Acosta M(et al.)
  3. Ann Thorac Surg v.54 Prolonged open sternotomy and delayed sternal closure after cardiac operations Furnary AP;Magovern JA;Simpson KA;Magovern GJ
  4. J Thorac Cardiovasc Surg v.83 Atypical tamponade after cardiac operation in infants and children Shore DF;Capuani A;Lincoln C
  5. J Thorac Cardiovasc Surg v.98 Delayed sternal closure: a lifesaving maneuver after early operation for complex congenital heart disease in the neonate Odim JNK;Tchervenkov CI;Dobell ARC
  6. Ann Thorac Surg v.32 Delayed strnal closure following open-heart operation Gielchinsky I;Parsonnet V;Krishanan B;Silidker M;Abel RM
  7. J Thorac Cardiovasc Surg v.91 Delayed sternal closure: an improvement method of dealing with complication after cardiopulmonary bypass Josa E;Khuri SF;Braunwald NS(et al.)
  8. J Cardiovasc Surg v.27 Delayed sternal closure following cardiac operations Milgater E;Uretzky G;Shimon DV;Silberman S;Appelbaum A;Borman JB
  9. Ann Thorac Surg v.44 Delayed sternal closure after cardiac surgery Fanning WJ;Vasko JS;Kilman JW
  10. Ann Thorac Surg v.56 Ultrafiltration and modified ultrafiltration in pediatric open heart operations Eliott MJ
  11. 대흉외지 v.28 신생아 개심술 후 지연 흉골 봉합 성시찬;이용훈;조은희;전희재;최필조;우종수
  12. Crit Care Med v.7 Right and left ventricular geometry: adjustments during acute respiratory failure Laver M;Strauss H;Prohst G
  13. Circulation v.81 no.SUP.3 Influence of the pericardium and ventricular interdependence on left ventricular diastolic and systolic function in patients with heart failure Janicki JS
  14. J Thorac Cardiovasc Surg v.107 Delayed sternal closure after neonatal cardiac operation Hakimi M;Walters Ⅲ HL;Pinsky W W;Gallagher MJ;Lyons JM
  15. J Thorac Cardiovasc Surg v.19 Hemodynamic effects of sternum closure after open-heart surgery in infants and children Jogi P;Werner O
  16. Am J Cardiol v.46 Application of transesophageal echocardiography to continuous intraoperative monitoring of left ventricular performance Matsumoto M;Oka Y;Strom J(et al.)
  17. Anesthesiology v.59 Changes in functional residual capacity during cardiac surgery Jonmarker C;Werner O;Nordstrom L
  18. J Thorac Cardiovasc Surg v.77 A proposed "solution" to the cardioplegic controversy Buckberg GD
  19. Am J Cardiol v.48 Intracardiac surgery in infants under age 3 months : predictors of postoperative in-hospital death Kirklin JK;Blackstone EH;Kirklin JW(et al.)
  20. Am J Cardiol v.48 Intracardiac surgery in infants under age 3 months:incremental risk factors for hospital mortality Kirklin JK;Blackstone EH;Kirklin JW(et al.)
  21. Ann Thorac Surg v.44 Delayed sternal closure after cardiac surgery Fanning WJ;Vasco JS;Kilman JW