儿童永久起搏器电池更换术后切口愈合不良两种治疗方案的对比研究

A comparative study of two treatment schemes for poor incision healing after battery replacement of permanent pacemaker in children

目的对比儿童永久起搏器电池更换术后切口愈合不良两种不同治疗方式的疗效。方法回顾性分析2001年1月至2019年11月行起搏器电池更换后出现切口愈合不良的11例患儿病历资料,其中男童7例,女童4例,平均年龄(7.3±2.5)岁,电池更换距离上一次起搏器电池植入时间(4.1±1.5)年,7例切口有脓性分泌物,4例有清亮分泌物。8例于术后3周内再次入院,3例分别于术后45 d、40 d、32 d再次入院。5例有低热症状,6例无发热症状。依据不同治疗方式分为手术组(n=6)和常规换药组(n=5)。手术组1例予囊袋扩大后清创缝合,5例予原囊袋切除清创缝合。常规换药组5例均予以头孢菌素或万古霉素抗感染,治疗碘伏纱布每日换药2次,其中2例予持续负压吸引2周。结果手术组6例患儿均在术后2周内痊愈出院,平均住院时间(11±3)d,均在术后3 d内拔除引流管,平均引流量(25.6±10.1)mL,术后电话随访,未再发生切口愈合不良。手术组6例患儿均未发生全身感染及感染性心内膜炎,伤口愈合良好,疗效满意。常规换药组平均住院时间(30±5)d,1例出院2个月后再次入院,拆除原腹部起搏器,更换为心内膜起搏器。两组患儿住院时间具有统计学差异(t=-9.6,P<0.01)。出院前手术组和常规换药组C反应蛋白测量值分别为(8.2±2.5)mg/L和(25.0±15.0)mg/L,差异有统计学意义(t=-2.8,P<0.05)。结论儿童永久起搏器电池更换术后切口愈合不良发生后,将原起搏器囊袋切除,减少异物植入,可吸收线间断缝合,适当游离皮片减少吻合口张力,可取得满意疗效。此方法与常规换药相比可明显缩短住院时间,减轻病人痛苦,降低再次感染的发生率。

Objective To compare two different treatment methods for poor incision healing after battery replacement of permanent pacemaker in children.Methods The medical records were analyzed retrospectively for 11 children with poor incision healing after pacemaker battery replacement at Fuwai Hospital and Hebei Yanda Hospital from January 2001 to November 2019.There were 7 boys and 4 girls with an average age of(7.3±2.5)years.The average time of battery replacement was(4.1±1.5)years since the last pacemaker battery implantation.The secretions were purulent(n=7)and clear(n=4).Eight children were readmitted within 3 weeks post-surgery while another three were readmitted at 45,40 and 32 days post-surgery respectively.Fever was low(n=5)and none(n=6).For facilitating statistical analysis,they were divided into operation group(n=6)and routine dressing group(n=5).In operation group,1 patient underwent enlarged bag debridement and suture and another 5 original bag resection and suture.All 5 patients in routine dressing group received cephalosporin or vancomycin.Iodophor gauze was replaced twice daily and two of them received continuous negative pressure suction for 2 weeks.Results All 6 patients in operation group were cured and discharged within 2 weeks post-surgery with an average length of stay of(11±3)days.The drainage tube was removed within 3 days post-surgery with an average drainage volume of(25.6±10.1)ml.Postoperative follow-ups by telephone showed no further adverse incision healing.None of them had systemic infection or infective endocarditis.Incision healing was decent and efficacy satisfactory.In routine dressing change group,the average hospital stay was(30±5)days.One patient was re-admitted 2 months after discharge.The original abdominal pacemaker was removed and replaced by an endocardial pacemaker.Significant inter-group difference existed in hospital stay(t=-9.6,P<0.01).Also significant difference existed in C-reactive protein before discharge(t=-2.8,P<0.05).Conclusion For poor healing of incision after battery replacement of permanent pacemaker in children,satisfactory outcomes may be obtained by removing the original pacemaker bag,reducing foreign body implantation,intermittent suturing of absorbable string and properly liberating skin slice for lowering anastomotic tension.As compared with routine dressing change,this method can significantly reduce the time of hospitalization,relieve the pain of patients and reduce the incidence of reinfection.