起搏器置入术后胆囊感染的相关因素分析

Single-center clinical analysis of gallbladder infections after pacemaker implantation

目的分析起搏器置入术后发生胆囊感染的临床资料,以期掌握胆囊感染的临床特点,根据高危因素加强预防,并为提高临床对胆囊感染的诊治水平提供参考。方法选取心脏起搏器置入患者1149例,回顾性分析其基本资料和治疗情况,对患者的性别、年龄、手术次数、手术时间、胆囊血肿发生、切口脂肪液化以及导管室的环境等因素进行统计处理,探讨胆囊感染的危险因素,对于发生胆囊感染的患者行细菌培养,确定病原菌种类。结果1149例起搏器置入患者共发生胆囊感染22例,感染率为1.91%,合并糖尿病、手术次数>2次、手术持续时间>3h、有胆囊血肿、切口脂肪液化等患者在术后发生胆囊感染概率明显高于不存在这些危险因素者(P<0.05);且经过logistic多因素回归分析,上述危险因素均为起搏器置入术后发生胆囊感染的独立危险因素(P<0.05);22例发生胆囊感染的患者中13例发生于术后1～6个月占59.09%,4例发生于术后6～24个月占18.18%,其余5例患者发生于术后>2年占22.73%;共检出病原菌29株,其中革兰阴性菌占72.41%,革兰阳性菌占24.14%,真菌占3.45%。结论心脏起搏器置入术后发生胆囊感染与多种因素密切相关,在临床工作中针对存在高危因素的患者应采取相应的预防措施,并在术后严格监测;一旦发生感染,应及时进行细菌培养和药敏试验,给予相应治疗。

OBJECTIVE To investigate the clinical data of the patients with gallbladder infections after pacemaker implantation,explore the clinical characteristics of the gallbladder infections,and strengthen the prevention of high-risk factors so as to improve the level of diagnosis and treatment of the gallbladder infections.METHODS Totally 1149cases of patients who underwent pacemaker implantation were enrolled in the study,then the general data and the treatment were retrospectively analyzed,the statistical analysis was performed for the risk factors,including the gender,age,frequency of operation,operation duration,incidence of gallbladder hematoma,incision fat fluid,and the environment of the catheter rooms,and the bacterial culture was carried out for the patients with gallbladder infections to determine the species of pathogens.RESULTS Of totally 1149cases of patients,the gallbladder infections occurred in 22cases with the infection rate of 1.91%;the incidence rate of postoperative gallbladder infections of the patients with complication of diabetes,operation frequency more than two times,operation duration more than 3hours,gallbladder hematoma,or incision fat fluid was significantly higher than that of the patients without those risk factors（P0.05）,and the multivariate logistic regression analysis indicated that all the risk factors above were the independent risk factors for the postoperative gallbladder infections in the pacemaker implantation patients（P0.05）.Of 22cases with postoperative gallbladder infections,there were 13（59.09%） cases with the infections occurring 1-6six months after the surgery,4（18.18%） cases 6-24months after the surgery,and 5（22.73%） cases more than 2years after the surgery.Totally 29strains of pathogens were isolated,among which the gram-negative bacteria accounted for 72.41%,the gram-positive bacteria 24.14%,the fungi 3.45%.CONCLUSIONThere are a variety of factors closely associated with the gallbladder infections after cardiac pacemaker implantation,it is necessary to take corresponding prevention measures aiming at the high risk factors and carry out the strict monitoring;once the infections occur,the bacterial culture and the drug susceptibility testing should be performed in a timely manner so as to carry out corresponding treatment.