起搏器囊袋感染新治疗方法的临床应用

Strategy of Preserve Counterlateral Side Non-Infective System in Treatment of Isolated Pacemaker Pocket Infection

目的探讨因一侧起搏器囊袋感染而在对侧植入新系统的患者中,仅拔除原有感染侧起搏器及电极导线而保留非感染系统的临床意义。方法入选2013年1月至2014年6月就诊于北京大学人民医院心脏中心,因一侧囊袋感染而在对侧植入新起搏系统的患者。根据治疗策略,入选患者随机分为两组,观察组:仅拔除单纯囊袋感染侧的原有系统,保留新植入的非感染系统;对照组:完全拔除两侧起搏系统。随访一年,对比两组原位囊袋感染复发及新增对侧感染情况。结果 2013年1月至2014年6月就诊于本中心,因单纯囊袋感染而在对侧植入新起搏器系统的患者共45例。其中,观察组23例,对照组22例。手术前一般情况比较,两组在性别(男性60.8%vs.54.5%,p<0.05),年龄(54.6±10.7 vs.57.1±8.9,p<0.05),首次植入时间(5.7±1.7年vs.6.4±2.2年,p<0.05),感染时间(13.4±4.2月vs.12.1±3.8月,p<0.05),新系统植入时间(7.4±2.9月vs.9.1±3.7月,p<0.05)均无统计学差异。两组患者分别进行单侧及双侧起搏器电极导线拔除术,观察组拔除方法(上腔静脉途径19例,下腔静脉途径4例)与对照组(上腔静脉途径9例,下腔静脉13例)相比存在统计学差异(p>0.05)。手术即刻成功率均为100%,两组均未发生严重手术并发症。随访一年,两组患者均未出现原位囊袋感染复发及对新增侧囊袋感染。结论因单纯囊袋感染而在对侧植入新起搏系统的患者中,仅拔除原有感染侧起搏器及电极导线而保留新植入非感染系统是一种可行的新处理方法。

Objective This study evaluated the strategy of preserve counterlateral side non- infective system in treatment of isolated pacemaker pocket infection. Methods From Jan 2013 to Jun 2014, patients with isolated PM pocket infection, who were implanted a new system in counterlateral side, in Heart Center of Peking university People Hospital, were enrolled. All of the subjects were divided into two groups based on different treatment. Patients in test group were extracted system of infective side while preserve the non- infective system of counterlateral side. Patients in control group were extracted system of both sides. Follow up for at least 1year. To compare the recurrence of pocket infection in former infective side or of the new infection in counterlateral side. Results From Jan 2013 to Jun 2014,there were 45 patients with isolated PM pocket infection were enrolled, who were implanted a new system in counterlateral side. 23 cases were assigned into test group, 22 in control group. The basic characteristics of both groups pre lead extraction shows that gender( male 60.8% vs. 54.5%,p<0.05), age( 54.6±10.7 y vs. 57.1±8.9y, p<0.05),duration from first implantation( 5.7±1.7y vs. 6.4±2.2y,p<0.05), duration of pocket infection( 13.4±4.2m vs. 12.1±3.8m, p<0.05), duration from implantation of new system( 7.4±2.9m vs. 9.1±3.7m, p<0.05). The patients in test group were extracted via superior vena cava in 19 cases while inferior vena cava in 4 cases. The patients in contol group were extracted via superior vena cava in 9 cases while inferior vena cava in 13 cases. There was significance in extract method between two groups. All of the cases in both groups were extracted system successfully, the acute success rate is 100%. There was no major complication in both groups. Post follow up of 1 year, there were no recurrence and new infection in both groups. Conclusions The method of extracting system of infective side while preserving the non- infective system of counterlateral side is a new appropriate strategy in treatment for patients with isolated PM pocket infection, in whom were implanted a new system in counterlateral side,