Hyperbaric Oxygen Therapy as an Adjunct Treatment for Patients with Sternal Infection, Osteomyelitis and Mediastinitis-A Case Report

高壓氧治療做爲胸骨切開手術術後併發骨髓炎與縱膈腔發炎之輔助治療病例報告與文獻回顧

余文光(Wen-Kuang Yu) ； 王家弘(Jia-Horng Wang)

《胸腔醫學》 23卷5期 (2008/10) Pp. 386-392

https://doi.org/10.29806/TM.200810.0012

摘要

因心臟胸腔手術而併發胸骨骨髓炎與縱膈腔炎在臨床上並不常見，然而此併發症會提高死亡率、住院天數與醫療費用。積極地清瘡手術與使用廣效性抗生素為目前主要治療方法。手術部位局部缺氧與缺血的致病機轉理論提供了使用高壓氧治療作為輔助治療之根據。我們在此提出一位因胸腺瘤開刀切除病灶而引發胸骨骨髓炎，縱膈腔炎傷口裂開之病例報告，經過清瘡手術與抗生素治療後仍無法有效控制傷口與感染情況，在使用高壓氧作為輔助治療後，整體情況進步迅速。之後病人接受皮瓣重建手術並且順利出院。我們提出此病例報告並做相關文獻回顧。

關鍵字

高壓氧治療 ； 胸骨骨髓炎 ； 縱膈腔炎 ； 胸骨切開術

並列摘要

Sternal infection and mediastinitis are uncommon but serious complications after cardiothoracic surgery via median sternotomy. They increase postoperative mortality, morbidity and overall cost. Early aggressive debridement and empiric antibiotic use are the primary treatment. The postulated mechanism of ischemia and hypoxia resulting in the development of sternal infection and mediastinitis provides a theoretical basis for the use of hyperbaric oxygen therapy (HBO). A review of case reports and some nonrandomized studies found that they all supported the use of HBO for sternal infection after cardiothoracic surgery. We report a case of sternal wound infection and osteomyelitis after median sternotomy. The patient received wound debridement and antibiotic treatment but without effect. After adjunct hyperbaric oxygen therapy, the sternal infection and mediastinitis improved dramatically and the patient was discharged without co-morbidity. We concluded that HBO therapy may be a variable adjunct treatment for sternal infection and mediastinitis after sternotomy.

並列關鍵字

hyperbaric oxygen therapy ； sternal osteomyelitis ； mediastinitis ； sternotomy