Objective To investigate the clinical features and pathogenic characteristics of different types of deep sternal wound infection in dif?ferent types after cardiac surgery. Methods A retrospective study was performed. From January 2012 to December 2014,84 patients with sec?ondary DSWI after cardiac surgery underwent the pectoralis major muscle flap transposition in our department were recruited for the study. Re?sults The average age of 84 patients with DSWI was 54.6 ± 14.8 years old,of which typeⅡDSWI patients were the most common(49/84, 58.3%). Both typeⅠand typeⅡDSWI patients showed typical clinical manifestations and early chest X?ray or Computerized tomography(CT) showed mediastinal widening(P<0.01). Some patients with typeⅢDSWI showed only local symptoms of surgery. The organisms most common?ly isolated in patients with DSWI were gram gram?negative bacilli(GNB,54.8%). Although there was no significant difference between the 3 types of DSWI patients(P>0.05),but the pathogenic results of the 3 types of those DSWI patients showed such a trend:typeⅠDSWI patients with GNB is was more common,and typeⅡDSWI patients was more prone to complicated infection. Conclusion Different types of DSWI may dis?play different features,the prevention and treatment of DSWI should be closely combined with the clinical manifestations and local pathogenic char?acteristics.

Objective To investigate the survival rate and status of cerebral performance category in patients who received cardiopulmonary resuscitation (CPR) with return of spontaneous circulation (ROSC) (abbreviated by ROSC-CPR) after discharge,and to analyze the risk factors which influencing the prognosis of these patients.Methods A retrospective analysis of the clinic data coming from the patients who received cardiopulmonary resuscitation with return of spontaneous circulation and admitted to the Department of Intensive Care Unit from January 2009 to December 2016 was carried out to find corresponding risk factors influencing the prognosis.Results A total of 185 patients who received ROSC-CPR with 59.5％ male,the average age of (67.15 ± 17.64) years old and the average Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score (28.80 ± 7.16) were divided into two groups,the survival group (n =56) and the death group (n =129).The total survival rate was 56/185 (30.3％).Compared to the death group,the usage rate of ventilation,blood purification and target temperature management in survival group was no significant (P ＞ 0.05).The most common aetiology of the survival patients was cardiogenic disease,but the number of those patients with the good cerebral performance category (CPC 1/2) discharged from hospital were 16 cases (8.6％).According to logistic analysis,high value of APACHE Ⅱ score,the duration from CPR to ROSC over 10 minutes,admission took place out-of-hospital were unfavorable predictors for the prognosis (P ＜ 0.05),while admission took place in the second four years and cases with cardiogenic aetiology were favorable predictors for the prognosis of these patients who suffered from ROSC-CPR.Conclusions The survival rate of the patients who received CPR with ROSC after discharge was still low,especially the rate of good status of CPC was very low.To shorten the duration from CPR to ROSC as possible as we can,and to strengthen target temperature management would improve the prognosis of the patients who received CPR with ROSC in our hospital in future days.

OBJECTIVETo analyze and summarize the clinical features and experience in surgical treatment of deep sternal infection (DSWI).

METHODSThis was a retrospective study. From January 2008 to December 2013, 189 patients with secondary DSWI after cardiac surgery underwent the pectoralis major muscle flap transposition in our department. There were 116 male and 73 female patients. The mean age was (54 ± 21) years, the body mass index was (26. 1 ± 1. 3) kg/m2. The incidence of postoperation DSWI were after isolated coronary artery bypass grafting (CABG) in 93 patients, after other heart surgery plus CABG in 13 patients, after valve surgery in 47 patients, after thoracic aortic surgery in 16 patients, after congenital heart disease in 18 patients, and after cardiac injury in 2 patients. Clean patients' wound and extract secretions, clear the infection thoroughly by surgery and select antibiotics based on susceptibility results, and then repair the wound with appropriate muscle flap, place drain tube with negative pressure. Of all the 189 patients, 184 used isolate pectoralis, 1 used isolate rectus, and 4 used pectoralis plus rectus.

RESULTSThe operative wounds of 179 patients were primary healing (94. 7%). Hospital discharge was postponed by 1 week for 7 patients, due to subcutaneous wound infection. Subcutaneous wound infection occurred again in 8 patients 1 week after hospital discharge, and their wounds healed after wound dressing. Nine patients (4. 7%) did not recover, due to residue of the sequestrum and costal chondritis, whom were later cured by undergoing a second treatment of debridement and pectoralis major muscle flap transposition. Eight patients died, in which 2 died of respiratory failure, 2 died of bacterial endocarditis with septicemia, 2 died of renal failure, 1 died of intraoperative bleeding leading to brain death and the 1 died of heart failure. The mortality rate was 4. 2% . The average length of postoperative hospital stay was (14 ± 5) days. The longest postoperative follow-up period was 40 months, the median time was 26 months, the follow-up rate was 83. 9% . Totally 179 patients were no-reinfected, 2 patients were reinfected because of artificial vascular rejection.

CONCLUSIONTo perform surgical debridement and then reconstruct the sternal defect with pectoralis major muscle flap actively for the patient is an effective measure to improve patient's survival rate.

Adult ; Aged ; Cardiac Surgical Procedures ; adverse effects ; Coronary Artery Bypass ; Debridement ; Female ; Heart Defects, Congenital ; Humans ; Incidence ; Length of Stay ; Male ; Middle Aged ; Pectoralis Muscles ; transplantation ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Sternum ; surgery ; Surgical Flaps ; Surgical Wound Infection ; surgery ; Wound Healing