不同的抗菌方案对起搏器植入术后预防感染的影响

Effect of different antibacterial plans on preventing infection after pacemaker implantation

目的评估起搏手术围手术期不同预防性抗菌方案对术后感染的影响,寻求较好的预防性抗菌方案。方法 2010年6月-2013年6月入选医院择期安装的单、双腔起搏病例270例,入选患者预防性抗菌药物均为头孢三代抗菌药物联合甲硝唑或联合克林霉素;根据抗菌方案不同分为3组,其中A组:110例,B组:110例,C组:81例,3组均在术前30min^2h预防性使用抗菌药物,术后使用抗菌药物A组持续1周、B组72h内、C组未使用;观察3组的术后发热病例数、白细胞计数及CRP升高例数,切口血肿及感染例数。结果 3组患者中术后发热发生率:A组5例为5.6%、B组6例为6.7%、C组3例为3.3%;术后白细胞及CRP升高1倍发生率:A组13例为14.4%、B组15例为16.7%、C组11例为12.2%;术后血肿发生率:A组4例为4.5%、B组3例为3.3%、C组2例为2.2%,组间比较差异均无统计学意义;入选的270例患者中,仅1例出现急性起搏囊袋感染;3组患者抗菌药物相关不良反应发生率:A组9例为10.0%、B组6例为6.2%、C组1例为1.1%,组间比较差异有统计学意义(χ2=6.511,P<0.05)。结论起搏器经规范消毒处理,给予起搏器植入术患者围手术期适当的护理和预防性应用抗菌药物,可有效减少术后感染的发生,制定适当的预防性抗菌药物的使用时间,可有效遏制术后感染,并能有效减少抗菌药物引起的不良反应。

OBJECTIVE To estimate the effect of different antibacterial plans on preventing infection after planting pacemaker ,so as to achieve a better antibacterial plan .METHODS A total of 270 patients who were treated with single chamber pacing or dual chamber pacing from Jan 2010 to Jan 2012 .And the third generation cephalosporin combined with metronidazole or colin enzyme as preventive antibiotic treated the patients .According to the differ-ent antibiotic plans ,the cases were divided into three groups （group A ,B and C）：100 cases ,110 cases and 85 cases respectively ,which were treated with preventive antibiotics at 30 min^to 2 hours before operation the group A was treated with antibiotics for one week ,the group B for 72 hours ,the group C without use of antibiotics .The fever ,leukocyte and CRP and hematoma were recorded and analyzed .RESULTS The number of cases with a fever after operation in three groups went as follows ：5 cases in group A ,the occurrence rate was 5 .6% ;6 cases in group B ,accounting for 6 .7% ,3 cases in group C ,accounting for 3 .3% .The number of cases with doubled leukocyte and CRP in three groups ：13 cases in group A ,the occurrence rate was 14 .4% ;15 cases in group B , accounting for 16 .7% ,11 cases in group C ,and accounting for 12 .2% .The number of cases with hematoma disease after operation showed ：4 cases in group A ,the occurrence rate was 4 .5% ,3 case in group B ,accounting for 3 .2% ;2 cases in group C ,and accounting for 2 .2% .The difference between each group significante .Only 1 case got acute pacemaker pocket infection out of 270 cases .In the three groups ,the number of cases with adverse drug reaction to antimicrobials in each group was 9 in group A （10 .0% ） ,6 in group B（6 .2% ） and 1 case in group C（1 .1% ） Comparison among groups had statistical significance （χ2 = 6 .5111 ,P＆lt; 0 .05） .CONCLUSION It′s important for reducing postoperative infection to provide properly nursing , preventive antibiotic and standard disinfection on pacemaker .It′s good for holding infection and reducing adverse reaction to draft a proper plan of preventive antibiotic .