植入式心脏起搏器与自动转复除颤器感染的发病机制和诊治

Pathogenesis,diagnosis and treatment of infection of implantable cardiac pacemaker and automatic defibrillator

心血管植入性电子装置(CIED)感染的发生日见增多,涉及植入物本身和导管感染以及囊袋、心内膜、动静脉软组织及血流感染等类型。这些救命装置感染的发病机制与多因素有关,诊断需要综合局部和全身症状、体征、食道和经胸超声及多途径(组织、分泌物、导管、血液)细菌培养等多方面来决定。治疗的关键策略包括是否需要移除感染的CIED装置、抗感染治疗疗程、是否需要植入新的CIED装置及其植入时机;作者提出了CIED感染的3级预防策略。

Cardiovascular implantable electronic device （CIED） infection has been increasing and the increasing rate of CIED infection is likely muhifactorial in cause, involving both hostand device-related factors tissues including infection of the CIED itself, catheters, and bloodstream. The pathogenesis of infection is capsular bags, endocardium, arteriovenous soft also related to many factors and diagnosis should be based on comprehensive local and systemic symptoms and signs, esophagus or transthoracic ultrasound examinations and bacterial cultures of tissues, secretions, catheters and blood. The key strategies of treatment include removing the infected CIED device if needed, anti-infective therapy, implanting new CIED devices and implantation timing. This study offers a three-level prevention strategy for CIED infection.