经静脉拔除感染的心律植入装置:一项单中心回顾性观察性研究

Removal of infected cardiac implantable electronic device through vein:a single center retrospective observational study

目的 分析因心血管置入型电子器械(cardiac implantable electronic device,CIED)感染经静脉拔除起搏电极导线的结果。方法 回顾性分析2018年1月至2020年12月因CIED感染于合肥市第二人民医院治疗的11例患者。其中男性8例,女性3例,平均年龄58.7岁。所有患者都经充分抗感染治疗后经静脉拔除感染电极。根据CIED种类,分为起搏器(peacemaker,PM)组、埋藏式心律转复除颤器(implantable cardioverter defibrillators,ICD)组及心脏再同步化治疗(cardiac resynchronization therapy,CRT)组,比较各组患者基线资料、危险因素、感染及治疗情况。结果 分别有6例(54.55%)、2例(18.18%)及3例(27.27%)患者发生PM、ICD及CRT相关感染。CIED感染患者多合并高血压、糖尿病及慢性心肾功能不全等基础病。所有CIED感染患者均表现为囊袋感染,皮肤脓肿为主要临床表现。感染组织培养检出率较低,细菌检出率不足50%。PM组及ICD组患者予二代头孢治疗后感染可以控制,CRT组患者多需用万古霉素/利奈唑胺等控制感染。1名(9.09%)患者予囊袋充分清创、脉冲发生器同侧置入新囊袋并予加强抗感染治疗后好转。2根(9.09%)导线部分拔除,20根(90.9%)导线完全拔除。其中4根(20%)徒手拔除,12根(60%)经锁骨下静脉拔除,4根(20%)经锁骨下静脉联合股静脉拔除,无并发症。结论 经静脉拔除感染电极是解决CIED感染的主要途径,股静脉途径拔除是对经锁骨下静脉途径拔除失败患者的有效补充。

Objective To explore the results of intravenous lead extraction due to cardiac implantable electronic device(CIED) infection.Methods A retrospective analysis was performed on 11 patients who underwent the treatment for CIED infection in the Second People’s Hospital of Hefei from January 2018 to December 2020.Among them,8 were male and 3 were female,with an average age of 58.7 years.All patients underwent intravenous removal of infected electrodes after adequate anti-infective therapy.The baseline characteristics,risk factors,infection and treatment conditions in the patients with CIED infection induced by pacemaker(PM),implantable cardioverter defibrillators(ICD) and cardiac resynchronization therapy(CRT) were compared.Results PM,ICD and CRT-related infections occurred in 6 cases(54.55%),2 cases(18.18%) and 3 cases(27.27%),respectively.CIED-infected patients often had underlying diseases such as hypertension,diabetes,and chronic heart and kidney insufficiency.All the patients with CIED infection presented with pouch infection,with skin abscess as the main clinical manifestation.The detection rate of infected tissue culture was low,and the detection rate of bacteria was less than 50%.The infection in PM and ICD group could be controlled after the treatment with second-generation cephalosporin,while vancomycin/linezolid were needed in most patients of CRT group.One patient’s peacemaker pocket was well debrided,implanted a new pulse generator ipsilaterally after intensive anti-infection treatment.2(9.09%) leads were partially removed,and 20 leads(90.9%) were completely removed.Among them,Four were removed manually,12(60%) via the subclavian vein,and 4(20%) via the subclavian vein combined with the femoral vein.No severe complications occurred.Conclusion Transvenous removal of infected electrodes are the main route to treat CIED infection,and femoral vein route removal is an effective supplement for the patients with failed removal via the subclavian vein route.