起搏器植入术后囊袋并发症的临床分析及处理：1368例报告

Pocket complications after pacemaker implantation： clinical analysis of 1368 cases

目的观察植入永久性心脏起搏器后的囊袋并发症，寻找其原因，探讨处理对策，以减少其发生率。方法系统性回顾总结白求恩国际和平医院心血管内科26年中1368例缓慢性或快速性心律失常患者囊袋并发症。结果1368例中，囊袋积血80例，发生率5．8％，抽吸或切开27例（2．0％），囊袋积血与高龄、营养状况差、术前未停用抗凝药物、血小板低、分离制作囊袋术中解剖层次不对及操作不细致等因素有关，而与起搏器重量、起搏器类型等无明显关系；及时发现，延长压迫时间，根据情况抽吸积血往往奏效，个别需切开引流。囊袋破溃6例，发生率0．4％，囊袋破溃主要与起搏器重量较大、囊袋深浅和（或）位置和（或）大小与起搏器不匹配、多余的电极导线盘绕有张力和（或）在起搏器浅面等有关，个别与排斥有关。囊袋感染3例，发生率0．2％，均为囊袋破溃后起搏器外露继发感染；局部彻底清创消毒后囊袋易位，配合全身抗感染、加强营养等处理部分病例有效，最终解决感染问题需电极导线拔除。结论囊袋并发症与患者体质有关，术前准备不充分、术中操作不细致、术后压迫或处理不当等也会增加囊袋并发症；术前充分准备，术中规范操作，及时发现并恰当处理，囊袋并发症可降低。

Objective To observe the pocket complications after permanent pacemaker implantation and to Imalyze the reasons and treatment strategies. Methods Pocket complications in 1368 cases of bradyarrhythmia or tachyarrhythmia in past 26 years were summarized. Results Of the 1368 cases, there were 80 cases of pocket hematoma （5.8%）, among which, 27 cases underwent blood aspirate or surgical incision. Incidence of pocket hematoma was related to factors such as age, poor nutrition, preoperative use of anticoagulant drugs, low platelet count, and incorrect anatomical hierarchy or careless manipulation during the operation. The pace- maker type and weight had no influence on its occurence. Timely discovery, longer compression time and necessary blood aspirate usually worked, and sometimes surgical incision was needed. There were 6 cases （0.4%） of pocket ulceration, which was related to factors such as large pacemaker, mismatch between the pocket and the pacemaker in depth, location and size, abundant leads and wires above the pacemaker, and occasional rejection reaction. There were 3 cases of pocket infection （0.2%）, which considered as secondary infection after pocket ulceration. Pocket translocation following thorough debridement, combined with general antibiotics application and nutrition improvement was effective. Electrode removal was required to thoroughly deal with the infection. Conclusions Pocket complications are associated with the patients＇ constitution. Inadequate preoperative preparation, careless manipulation and inappropriate postoperative treatment are also the risk factors. Incidence of pocket complications can be reduced by careful pre-operation preparation, standard manipulation, timely discovery and appropriate treatment.