起搏器植入术中两种不同切口缝合方法的应用比较

Comparison of two different incision suture methods for the implantation of cardiac pacemaker

目的比较起搏器植入术两种不同切口缝合方法的缝合时间和对切口愈合的影响。方法入选2011年1月至2014年1月苏北人民医院心内科接受心脏永久起搏器治疗的462例患者，按照手术日期的单双号随机分为2组：A组，医用皮肤表面缝合器拉合法：起搏器184例，植入型心律转复除颤器（ICD）13例，心脏再同步治疗起搏器（CRT）18例，其中更换34例；B组，使用连续皮内缝合：起搏器209例，ICD11例，CRT27例，其中更换46例。结果两组患者性别、年龄、伴随疾病（高血压、冠心病、糖尿病等）及抗凝药使用差异无统计学意义。A组缝合时间明显短于B组[（3．5±1．2）min对（8．5±2．1）min，P〈0．01]。23例患者出现囊袋血肿，A组明显少于B组（6例对17例，P〈0．05）。所有患者均I期甲级愈合，47例患者切口瘢痕较大，A组明显少于B组（15例对32例，P〈0．05）。结论采用皮肤表面缝合器拉合法能明显缩短缝合时间，降低囊袋血肿和巨大瘢痕的发生率。

Objective To compare the time taken and effect on wound healing of two different incision suture methods for the implantation of cardiac pacemaker（PM）. Methods The medical records of 462 patients undertaken cardiac PM were collected from department of Cardiology in Subei People＇ s Hospital of Jiangsu Province from Jan 2011 to Jan 2014. All cases were divided into two groups according to number odd and even of operation dates. Two hundred fifteen patients received skin stitching instrument were randomized into Group A [ 184 PM, 13 implantable cardioverter defibrillator （ICI））, 18 cardiac resynchronization therapy （CRT）, and 34 generator replacements 1. The other 24/cases were assigned to Group B （209 PM, 11 ICD ,27 CRT, and 46 generator replacements）. Results There were no differences regarding age, gender, diabetes, coronary heart disease,renal insufficiency, hypertension, and oral anticoagulants. The suture time in group A was markedly shorter than that in group B[ （3.5±1.2） rain vs. （8.5±2.1） min,P〈0. 01 ] o Totally 21 cases experienced a hematoma on pacemaker pocket of which 17 patients were in the group B while 6 patients in group A（P〈 0. 05 ）. All incisions were healed in grade A. Compared with group A, group B has a higher rate of large incision sear （15 vs. 32 ,P〈0. 05）. Conclusion The skin stitching instrument could markedly shorten suturing time, decrease the incidence of hematoma on pacemaker pocket and large incision scar.