起搏器囊袋感染患者导线拔除术后再植入时间的临床分析

Time interval of reimplantation with post lead extraction in patients with isolated pacemaker pocket in- fection

目的探讨单纯起搏器囊袋感染患者导线拔除术后48h再植入新系统的安全性和可行性。方法入选2013年6月至2014年6月因单纯起搏器囊袋感染就诊于北京大学人民医院心脏中心的起搏器依赖患者80例，其中术前和术后血培养均为阴性者60例纳入本研究。人院后，均接受常规起搏器囊袋局部清创及导线拔除术。术中植入临时心脏起搏器，保留至再植入术后即刻移除。根据术后再植入时间，入选患者随机分为2组，观察组：导线拔除术后48h进行再植人手术；对照组：导线拔除术后72h进行再植人手术。随访1年，对比2组患者起搏器相关感染的发生率。结果60例患者分为2组，观察组30例，对照组30例。手术前，2组在性别（男56．7％对63．3％，P〉O．05），年龄[（58．2±11．2）岁对（55．5±9．9）岁，P〉O．05]、植入时间[（12．7±3．4）年对（10．6±2．8）年，P〉0．05]、感染时间[（16．5±5．2）个月对（13．2±4．6）个月，P〉0．05]上差异均无统计学意义。手术即刻成功率均为100％，观察组发生1例心脏压塞，1例中度三尖瓣反流，对照组发生2例心脏压塞。2组手术并发症发生率均为6．7％（P〉O．05）。术后即刻进行血培养，2组均未出现阳性患者。2组患者都于对侧植入新起搏系统，再植入成功率均为100％。随访1年，2组患者均未出现再植人装置相关感染。结论术后48h再植入新系统可应用于因单纯起搏器囊袋感染而进行导线拔除术的患者。

Objective This study evaluated the strategy of 48-hour interval of reimplantation a new system post lead extraction in patients with isolated pacemaker （PM） pocket infection. Methods From June 2013 to June 2014 ,PM dependent patients with isolated PM pocket infection were enrolled. All of the subjects accepted PM removal and lead extraction with temporary pacing preserve till reimplantation, and were divided into two groups based on different interval of reimplantation post lead extraction. Patients in test group were re- implanted a new PM system with 48-hour interval post lead extraction. Patients in control group were reimplant- ed a new PM system with 72-hour interval post lead extraction. All patients were followed up for at least lyear. The incidence of reimplantation related infection was compared. Results From June 2013 to June 2014,there were 60 patients with isolated PM pocket infection. All of the subjects accepted PM removal and lead extrac- tion. Thirty eases were assigned into test group, and the other 30 were in control group. There were no signifi- cant difference in gender（male 56.7% vs. 63.3% ,P〉0.05）,age[（58.2±11.2）y vs. （55.5±9.9）y,P〉 0. 05 %, duration from first implantation [ （12. 7±3. 4 ）y vs. （10. 6±2. 8 ）y, P〉0. 05 ], duration of pocket infec- tion[ （16. 5±5.2）m vs. （13.2±4. 6）m,P〉0. 05] between the two groups. The success rate of lead extraction was 100% in both groups. One case had cardiac temponade and I case had moderate tricuspid regurgitation in test group. Two cases had cardiac temponade in control group. There were no significant differences of proce- dure related complications in both groups. There were no patients with positive blood culture in both groups. Post follow-up period was at least 1 year, and there were no re-implantation related infection in both groups. Conclusion The method of 48-hour interval post lead extraction is a reasonable choice in patients with isolated PM pocket infection.