围术期预防性使用抗生素对高龄起搏器置入患者安全性评价

Safety evaluation of perioperative preventive use of antibiotics in pacemaker implantation in senile elderly patients

目的评价围术期24 h内预防性使用抗生素对置入起搏器的高龄患者预防感染发生的安全性。方法对置入心脏起搏器的115例高龄患者分两组,围术期24 h内使用抗生素的预防组（55例）和常规术前及术后使用抗生素的常规组（60例）,比较两组囊袋血肿、囊袋感染、伤口感染、肺部感染、住院天数、术后1-3个月感染、术后6个月再次入院等情况。结果术后发生并发症共20例（17.39%）,预防组和常规组发生囊袋血肿分别为2例（3.64%）和3例（5.00%）,肺部感染5例（9.09%）和6例（10.00%）,住院天数（25.63±7.25）d和（23.87±8.12）d,术后1-3个月内发生感染3例（5.45%）和3例（5.00%）,6个月内再入院14次（25.5%）和13次（21.7%）。术后并发症、术后肺部感染、住院天数、术后1-3个月内发生感染数、6个月内再入院数两组比较,差异均无统计学意义（P〉0.05）。结论对于置入心脏起搏器的高龄患者,围术期24 h内预防性使用抗生素并未增加术后感染风险,提倡在高龄起搏器置入患者围术期合理规范使用抗生素。

Objective To evaluate safety of 24 h perioperative preventive use of antibiotics in pacemaker implantation in senile elderly patients. Methods One hundred and fifteen patients beyond 80 years old who had been scheduled for permanent pacemakers implantation were divided into two groups：55 cases received preventive use of antibiotics within 24 h perioperatively; another60 cases were given perioperative and postoperative antibiotics as routine use. Data included pocket haematomas,infection of pacemaker pocket,infection of incision,pulmonary infection,days of in-hospitalization,times of infection after operation 1 - 3 months,times of readmission because of pacemaker implantation were collected. Results There were 20 complications totally（17.39%）.There were 2 pocket haematomas（3.64%） vs. 3 pocket haematomas（5.00%）,5 pulmonary infection（9.09%） vs. 6 pulmonary infection（10.00%）,3 episodes of infection after operation 1 - 3 months（5.45%） vs. 3 times of infection after operation 1 - 3 months（5.00%）,14 occurrence of readmission because of pacemaker implantation（25.5%）vs. 13 episodes of readmission because of pacemaker implantation（21.7%） in 24 h preventive antibiotics use group vs. routine usage group,respectively. No significant differences were found in postoperative complications,pulmonary infection,days in-hospital,times of infection after operation 1 - 3 months and times of readmission because of pacemaker implantation. Conclusion The risks of infection after pacemaker implantation do not increase in 24 h perioperative antibiotic use for pacemaker implantation in senile elderly. This method seems to be reasonable to be-come standard prescription for preventive usage of antibiotics perioperatively for pacemaker implantation in senile elderly.