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Brazilian Journal of Cardiovascular Surgery

Print version ISSN 0102-7638

Rev Bras Cir Cardiovasc vol.11 no.3 São José do Rio Preto Sept. 1996

https://doi.org/10.1590/S0102-76381996000300008 

ARTIGOS ORIGINAIS

 

Mediastinite em cirurgia cardíaca: análise dos fatores de risco e avaliação do tratamento utilizando irrigação contínua com solução de PVPI a 1%

 

Mediastinitis in cardiac surgery: evaluation of risk factors and treatment with continuous irrigation with PVPI 1% solution

 

 

Luiz Cláudio Moreira Lima; Fernando Antônio Roquete Reis Filho; Leonardo A. Gonçalves; Maurício C. Gomes; Luciana Casséte; Raul Corrêa Rabelo; Rodrigo de Castro Bernardes

Do Instituto do Coração do Hospital Madre Tereza

Endereço para correspondência

 

 


RESUMO

Com o objetivo de avaliar a eficácia do tratamento da mediastinite com irrigação contínua com solução de polivinilpirrolidona-iodo (PVPI) a 1 %, associada a antibioticoterapia e analisar os fatores de risco desta grave infecção, foram estudados, retrospectivamente, 1113 pacientes submetidos a cirurgia para correção de lesões cardíacas, entre janeiro de 1993 e abril de 1995, no Instituto do Coração do Hospital Madre Teresa, Belo Horizonte, Minas Gerais. Onze fatores de risco para mediastinite foram analisados (idade, sexo, peso, diabetes, hipertensão arterial sistêmica, tabagismo, transfusão sangüínea, tempo de circulação extracorpórea, utilização de enxerto de artéria torácica interna, drenagem pleural e tempo de internação preoperatorio). A análise estatística demonstrou serem fatores de risco: peso (p=0,0001), utilização de enxerto de artéria torácica interna (p=0,001), drenagem de pleura (p=0,001) e tempo de internação pré-operatório (p=0,01). Dezoito (1,6%) pacientes desenvolveram mediastinite no pós-operatório e foram submetidos a tratamento por aesbridamento cirúrgico, ressutura de esterno e instalação de irrigação contínua com solução de PVPI a 1 %, por um período médio de 8 dias. A média de internação hospitalar foi de 37 dias neste grupo de pacientes. O germe predominante foi o S. Aureus (72%). A mortalidade foi de 27% (5 pacientes), devido a infecção fora de controle. Os autores consideram que a facilidade de emprego e manejo da irrigação contínua com solução de PVPI a 1 %, associada a baixa taxa de mortalidade, demonstrou ser um método eficaz no tratamento desta grave complicação pós-operatória.

Descritores: Mediastinite, epidemiologia. Mediastinite em cirurgia cardíaca, fatores de risco. Cirurgia cardíaca, efeitos adversos. Mediastinite, quimioterapia.


ABSTRACT

In order to evaluate the efficacy of mediastinitis treatment with continuous wound irrigation with PVP11 % solution, plus antibyotics and surgical treatment, and to analise the risk factors of this serious infection, we retrospectively studied 1113 patients submited to cardiac surgery, between. January 1993 and April 1995, at the Instituto do Coração do Hospital Madre Tereza, Minas Gerais, Brasil. Eleven risk factors to mediastinitis were analized: age, sex, weight, diabetes, hypertension, smoking, blood transfusion, lenght of cardiopulmonary bypass (CPB), use of internal thoracic artery graft, pleural drainaige and hospital stay prior to surgery. Eighteen (1.68%) patients developed mediastinitis in the postoperative period and were treated with surgical intervention, continuous irrigation with PVP 11 % solution and antibyotics, during an average of 8 days. The hospital stay for this group of patients was in average 37 days. The predominant microorganism found was S. aureus (72%). The mortality was 27% (5 patients) due to disseminated infection. The authors conclude that continuous wound irrigation with PVP 11 % solution was an ease procedure with low mortality rate. The present method is effective in the treatment of this serious post-operative complication.

Descriptors: Mediastinitis, epidemiology. Mediastinitis in heart surgery, riskfactors. Heart surgery, adverse effects. Mediastinitis, drug therapy.


 

 

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Full text available only in PDF format.

 

 

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Endereço para correspondência:
Luiz Cláudio Moreira Lima
Rua Professor Júlio Mourão, 55 - Apt 101. Luxemburgo
Belo Horizonte, MG, Brasil. CEP 30380-340
Tel. 344-4228

 

 

Trabalho realizado no Instituto do Coração do Hospital Madre Tereza. Belo Horizonte, MG. Brasil.
Apresentado ao 23º Congresso Nacional de Cirurgia Cardíaca. Recife. PE. 20 a 30 de março 1996.

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