心血管植入型电子器械囊袋感染患者保守治疗的临床效果分析

Clinical effect analysis of conservative treatment on patients with cardiovascular implantable electronic device pocket infection

目的评价心血管植入型电子器械(CIED)囊袋感染患者保守治疗的临床效果,为其治疗提供理论指导及依据。方法选取2008年2月-2013年9月于医院接受治疗的心血管植入型电子器械囊袋感染患者14例作为研究对象,其中9例未移除全套起搏系统为观察组;另5例为对照组全部拔出装置,移除感染囊袋,在对侧重新植入;观察并详细记录两组患者感染病原菌类型、清创次数、再次发生感染例数及初次清创的有效率;采用SPSS21.0软件进行统计分析。结果观察组患者初次清创有效率为33.34%,其中6例患者再次感染,进行了二次清创,有2例患者反复复发,进行了多次清创;对照组患者中4例预后情况良好,初次清创效率为80.00%,有1例复发,再次清创后,情况良好,未发生再次感染,感染病原菌以革兰阳性菌为主,主要为金黄色葡萄球菌和表皮葡萄球菌,其次为革兰阴性菌。结论 CIED囊袋感染患者通过局部清创,抗菌药物浸润冲洗,合理处置心脏起搏装置,加之抗感染治疗,对控制感染有一定疗效。

OBJECTIVE To evaluate the use of conservative treatment on patients with cardiovascular implantable electronic device pocket infection so as to provide theoretical guidance and reference for treating pocket infection.METHODSFrom Feb.2008 to Sep.2013,14 cases of patients with the treatment of cardiovascular implantable electronic devices and got capsular bag infection were selected as study objects.Among them,9patients who did not remove a full-pacing system were regarded as the observation group.Other 5cases as the control group had their full set of pacing system and infected capsular bag removed and new set was replanted in the opposite side.The pathogen types,clearance times,recurrence of infection and effective rate after first clearance were observed and recorded in details.All data were statistically analyzed by SPSS 21.0.RESULTSThe effective rate after first clearance of the observation group was 33.34%.Among them,6cases had good prognosis and received the second clearance,and 2cases relapsed and received several clearance.In the control group,4cases had good prognosis and the effective rate of first clearance was 80.00%.Only one case got relapsed and turned well after the second clearance.No infection reappeared.Gram-positive bacteria,mainly including Staphylococcus aureus and Staphylococcus epidermidis,were proved to be the major pathogens,followed by gram-negative bacteria.CONCLUSION Local clearance,washing with antibiotics,rational placement of heart pacemaker and anti-infection treatment have certain effect on controlling infection in CIED pocket-infected patients.