開心手術關胸前塗抹萬古黴素以降低深部胸骨傷口感染之實證照護

Evidence-based Care of Topically Applying Vancomycin before Closing Sternotomy in Open-Heart Surgery to Reduce Deep Sternal Wound Infection

接受正中胸骨切開的開心手術病人術後若發生深部胸骨感染，不僅延長住院天數，增加照護時數與醫療成本，亦會增加死亡風險。本文描述一位47歲男性因冠狀動脈疾病須接受開心手術，因本身為腎移植病人，擔心服用免疫抑制劑會增加胸骨傷口感染的機率，因而延遲手術。作者透過實證5A步驟尋找開心手術預防胸骨感染之文獻，進行閱讀與評析，發現在關閉胸骨前將萬古黴素2.5克混合於2毫升生理食鹽水塗抹於胸骨切割面合併預防性抗生素使用能降低胸骨感染率，進而引導醫療團隊與個案及家屬共同決策，將此實證結果應用於個案。然而，預防性措施於單一個案的應用無法直接歸因於所給予的措施，未來應進行大樣本的隨機對照試驗，以進一步支持本實證應用的結果。

When a patient who has undergone open-heart surgery with median sternotomy develops deep sternal wound infection, it not only increases the days of hospitalization and medical costs but also the mortality rate. In this paper, we report a case where a 47-year-old male underwent cardiac surgery for coronary artery bypass. The patient received a kidney transplant 5 years ago, and the use of immunosuppressants increased the risk of post-operative sternal wound infection. The author utilized evidence-based 5A research methods and systematically searched databases for methods to prevent sternal wound infection. Through thorough appraisal, the author found that mixing 2.5 grams of vancomycin with 2 milliliters of normal saline produced a wax-like substance that can be rubbed onto the cut-edges of the sternum, lowering infection risks. The author prompted the medical team to conduct a shared decision-making conference with the patient and his family to utilize this infection-lowering method for the patient himself. Larger randomized controlled trials are needed to provide more solid evidence for this practice.