护理干预对心脏再同步化及除颤治疗后囊袋感染和相关问题的影响

The influence of nursing intervention on the pocket infection and other related problems following cardiac resynchronization therapy and implantable cardiac defibrillator therapy in chronic heartfailure patients

目的探讨护理干预对心脏再同步化和除颤（CRT—D）治疗慢性心力衰竭发生囊袋感染及相关问题的影响。方法回顾2008年3月至2011年3月行CRT-D治疗的54例对照组患者发生囊袋皮肤机械性破溃及切口裂开、囊袋出血或血肿等及囊袋感染的原因，进行分析、总结，针对要因制定护理干预措施。对2011年4月至2013年6月行CRT-D治疗的79例干预组患者实施护理干预，比较2组患者术后6个月内囊袋皮肤机械性破溃及切口裂开、囊袋出血或血肿及囊袋感染的发生情况。结果实施护理干预后，接受CRT—D治疗患者的囊袋感染及相关问题的发生率较实施前显著降低。结论术前严谨的皮肤准备、消除潜在感染因素，术中严格无菌操作、选择合适的囊袋位置、实施预防出血干预措施，术后细致、严密的观察护理、充分的健康知识指导、加强跟踪随访、及时发现问题并处理，能有效的预防CRT-D治疗患者囊袋皮肤机械性破溃及切口裂开、囊袋出血、血肿及囊袋感染的发生。

Objective To explore the influence of nursing intervention on the pocket infection and other related problems following CRT-D therapy in chronic heart failure patients. Methods The causes of pocket machinery burst and skin incision dehiscence, pocket bleeding or hematoma and pocket infection following CRT-D therapy from March 2008 to March 2011 were reviewed, then analyzing and summarizing them to work out a detailed nursing interventions plan. During April 2011 to June 2013, nurses carried out the nursing intervention on patients who accepted CRT-D implantation. At last we compared the occurrence of pocket machinery burst and skin incision dehiscence, pocket bleeding or hematoma and pocket infection during the period of 6 months after CRT-D therapy between the two groups. Results After the implementation of nursing interventions, the incidence of pocket infection and other related problems following CRT-D therapy in chronic heart failure patients reduced significantly. Conclusions The interventions such as rigorous preoperative skin preparation, eliminating the potential factors of infection, intraoperative strict aseptic operation, choosing the appropriate position of pocket, the implementation of interventions to prevent bleeding, meticulous and rigorous postoperative nursing, providing healthy knowledge sufficiently and strengthening follow-up, finding problems and solving them timely can prevent the pocket machinery burst and skin incision dehiscence, pocket bleeding or hematoma and pocket infection following CRT-D therapy effectively.