患者起搏器囊袋感染的危险因素

Risk factors of patients with pacemaker pouch infection

目的了解近年来患者起搏器囊袋感染的危险因素。方法回顾性分析2011年1月至2016年9月年在浙江省人民医院行永久性心脏起搏器植入的863例患者，统计患者病历资料、起搏器和起搏器手术情况、感染及其处理情况，并分析起搏器囊袋感染的相关危险因素。结果863例患者中发生起搏器囊袋感染共27例，平均年龄（68．3_＋10．0）岁，21例均为男性，合并高血压、糖尿病、房颤等较多基础疾病；感染主要发生于术后中期（1~12个月）和远期（〉24个月）。Logistic回归分析表明，起搏器囊袋感染与男性（OR=8．288，95％C1：2，830~24．275）和心力衰竭（OR=3．280，95％CI：1．485-7．248）相关。感染病原菌多为葡萄球菌，囊袋感染直接行装置拔除加囊袋清创的有效率稍高于行抗感染治疗或囊袋清创，抗菌谱同时覆盖葡萄球菌和肠杆菌的抗感染药物效果较好。结论起搏器囊袋感染发生率不低，男性和心力衰竭是感染发生的危险因素。

Objective To investigate the risk factors of patients with pacemaker pouch infection （PPI）. Methods From January 2011 to September 2016, a total of 863 cases performed pacemaker implantation in Zhejiang Provincial People＇s Hospital were enrolled. The medical history, pacemakers, pacemaker implantation, PPI and its treatment were collected, while the risk factors related to pacemaker pouch were analyzed. Results Among 863 cases, 27 cases occurred PPI. The average age of PP] patients was （68.3＋10.0） years old, and 21 cases were male. Most PPI patients complicated underlying diseases like hypertension, diabetes and atrial fibrillation. Infection mainly occurred in the medium （1-12 months） and long term（〉24 months） periods after implantation. The logistic regression analysis showed that PPI occurred more often in males（OR=8.288, 95%CI： 2.830-24.275） and patients with heart failure （0R=3.280, 95%C1： 1.485-7.248）. The main pathogens were Staphylococcus. Direct removal of pacemaker plus pouch debridement was the slightly more effective than anti-infective therapies or pouch debridement in PPI cases, and antibiotics with the spectrum covered both Staphylococcus and Enterobacter got better results. Conclusions The incidence rate of PPI is not low. Male and heart failure are the risk factors for the infection.