永久起搏器置入患者预防性应用抗生素临床分析

Retrospective clinical analysis of prophylactic antibiotics in patients with pacemaker implantation

目的:回顾性分析永久起搏器置入患者围术期不同方式预防性应用抗生素的疗效。方法:收集兰州大学第二医院心内科和兰州军区总医院心内科行永久起搏器置入术的722例患者的临床资料,根据抗生素用药方案分为4组。A组(n=187)、B组(n=183)、C组(n=174)均在术前30 min^1 h预防性静脉滴注抗生素1次,术后A组使用抗生素平均(6.52±1.13)d,B组使用3 d,C组术后未使用,D组(n=178)术前、术后均未使用抗生素。4组患者术后第1、3、5天常规各换敷料1次,住院期间观察手术切口和囊袋,并分别在术后1个月、3个月门诊或电话随访1次。结果:4组患者术后发热、切口红肿及囊袋积血发生率及感染率均无显著差异。结论:延长预防性使用抗生素疗程未能显著降低永久起搏器置入患者感染发生率。

Objective：To retrospectively analyze the features of antibiotic use in preoperative period of permanent cardiac pacemaker. Methods：A total of 722 patients with single,dual and three chamber cardiac pacemaker from Cardiology Department of the second Hospital affiliated to Lanzhou University and Cardiology Department of General Hospital of Lanzhou Military Command between January 2010 and December 2013 were enrolled.According to the different antibiotic therapeutic regimens,the patients were divided into group A（n=178）,group B（n=183）,group C（n=174）and group D（n=178）.In group A,B and C,the patients were administered intravenously prophylactic antibiotics 30min-1hbefore the surgery.The durations of antibiotic use in group A and group B were（6.52±1.13）d three days,respectively.We changed the dressing for all patients on the first,third and fifth day after surgery,observed condition of surgical incision and pocket during hospitalization stay,and followed up at the first and third month respectively after the surgery in outpatient department or by telephone. Results：There were no statistical differences among these four groups in postoperative fever rate,surgical incision swelling and infection rate of the pocket hematocele. Conclusion：Prolonged prophylactic antibiotics treatment fails to decrease the incidence of infection in patients with permanent pacemaker implantation.