起博器外露的处理方法及原因分析

The cause analysis and management of pacemaker exposure

目的探讨起博器置入术后外露的处理方法及原因分析。方法先行起博器处分泌物的培养加药敏试验;然后切除感染皮肤,将起博器取出后用碘伏浸泡,同时清除腔隙内感染的肉芽组织和增生的纤维组织,用双氧水和甲硝唑液反复冲洗;于起博器上缘沿胸大肌的肌纤维走行,将胸大肌的肌纤维分开形成胸大肌、胸小肌腔隙,并将腔隙剥离得足够大,重新置入起博器;分层缝合切口后放置负压引流。结果自2000年1月至2006年12月,对6例起博器外露患者进行了处理,术后伤口均Ⅰ期愈合。随访患者3～6个月,无再次起博器外露及感染的发生。结论起博器外露其后果较严重,采用积极及适当的处理方法（将起博器置入胸大肌下）是减少并发症的发生、获得良好处理效果的关键。

Objective To investigate the cause and management of pacemaker exposure. Methods Secretion from the wound bed was cultured and antibiotic sensitivity test was performed preoperatively. During surgery, the infected skin was excised, paemaaker was taken out and sterilized by iodophor. Meanwhile, infected granulation tissue and hyperplasfic fibrous tissue inside the pocket were also cleared out. The wound was washed thoroughly by hydrogen dioxide and metronidazole solution. On the upper edge of pacemaker, the musculus peetoralis major was divided along the fiber, and a new pocket was undermined between the musculus pectoralis major and minor. The pacemaaker was inserted into the new pocket, the wound was closed by layers, and a suction drainage was put inside the pocket. Results From Jan. 2000 to Dec. 2006, a series of six patients was treated by this method. The wound- healed primarily. The patients were followed up for 3～6 months. There was no infection or re- exposure occurrence. Conclusion Although pacemaker exposure was a serious results, through aggressive treatment （insert the pacemaker underneath the musculus pectoralis major） can effectively reduce the occurrence of complications.