口服抗凝药所致心血管植入型电子器械囊袋迟发性血肿的临床特征和处理策略

Clinical characteristics and management strategies of delayed pocket hematoma in patients with cardiac implantable electronic devices which caused by oral anticoagulant

目的探讨口服抗凝药导致的心血管植入型电子器械(cardiovascular implantable electronic device,CIED)迟发性血肿的临床特点和处理策略。方法回顾性分析了2017年1月至2018年7月在中南大学湘雅二医院及湘雅三医院植入CIED 841例患者,定义迟发性囊袋血肿为植入装置后5 d以后发生的囊袋血肿,采集其临床资料并分析其处理策略。结果在植入后(12.0±8.8)个月的随访期,共发生囊袋血肿9例,发生率为1.1%,其中迟发性囊袋血肿5例,发生率为0.6%。2例经过加压包扎保守治疗痊愈,2例经过囊袋血肿清除术后痊愈,1例血肿抽吸并保守治疗的患者后期出现囊袋破溃并感染,经装置移除并重新植入后痊愈,无死亡病例。因本研究为小样本描述性研究,未行统计学分析。迟发性囊袋血肿特点为患者正在接受抗凝药治疗,无明显全身或局部炎症反应,囊袋积液镜检及培养无细菌检出,局部组织无明显炎症破坏,经血肿清除术或保守治疗后囊袋积液迅速吸收。结论CIED植入后可能会发生迟发性血肿,发生原因可能和抗凝药使用以及监测不够规范相关。根据其临床特点可以和感染性积液鉴别,通过血肿清除术或保守治疗多数患者预后良好。

Objective To investigate the clinical features and management strategies of delayed hematoma in cardiac implantable electronic devices(CIED)patients which caused by oral anticoagulant drugs.Methods Retrospective analysis of 841 patients with CIED from January 2017 to July 2018 in Xiangya Second Hospital and Xiangya Third Hospital.Delayed pocket hematoma was defined by a pocket hematoma occurred at least 5 days after the device implantation,clinical data,and its treatment strategy were collected and analyzed.Results In the follow-up period of(12.0±8.8)months after implantation,9 cases of pocket hematoma occurred,which the incidence rate of was 1.1%.Five cases of delayed pocket hematoma occurred,which the occurred incidence rate of was 0.6%.Two cases were healing after pressure-wrapped and conservative treatment.Two patients recovered after hematoma evacuation.One patient with hematoma aspiration and conservative treatment developed pocket rupture and infection in the later stage.He recovered after the device was removed and re-implanted.There was no death.There is not any statistics analysis because of small size of patients.Delayed hematoma is characterized by often occurring in patients receiving anticoagulant therapy,no obvious systemic or local inflammatory response,pocket effusion microscopic examination and culture without bacterial detection,without local tissue inflammatory damage,hemorrhage or the effusion was quickly absorbed after conservative treatment.Conclusion There is a certain incidence of delayed hematoma after CIED implantation.It is primarily related to the use of anticoagulant drugs,especially non-standardized use.According to its clinical features,it can be differentiated from infectious effusion,and it can be treated by hematoma evacuation or conservative treatment.