起搏器置入术后囊袋感染单中心病历资料分析

目的起搏器囊袋感染是起搏器置入术后常见的并发症之一,严重者可以并发心内膜炎而危及生命。本研究针对囊袋感染的治疗及效果进行了总结。方法纳入2002年至2008年院内顺序收治的52例起搏器囊袋感染患者。分析影响首次手术即发生囊袋感染的危险因素和囊袋感染首次治疗后复发的危险因素。结果共入选起搏器囊袋感染患者52例,平均年龄60.6±17.2岁,男性31例。53.9%患者置入双腔起搏器,30.8%合并2型糖尿病;末次手术距首次诊断囊袋感染的平均间隔时间为571.9±790.8天,其中42.3%的患者首次囊袋感染发生于末次手术1年以上。50%的患者为首次置入起搏系统后出现囊袋感染,这些患者置入双腔起搏器的比例有高于二次手术后发生感染患者组的趋势（p=0.06）,包括年龄在内的其他临床特征没有显示出统计学差异。Logistic回归分析发现首次诊断感染患者进行清创术后复发的危险性仅与是否移除整套起搏系统这一治疗措施呈负相关（RR0.11,95%CI,0.02-0.51,p〈0.01）。结论针对起搏器术后囊袋感染的处理只有完全移除整套起搏系统才是真正有效地治疗方法。

Prognosis of Device-Related Infection among Patients with Pacemakers and Implantable Defibrillators

Objective The device-related infection becomes a major limitation of pacemaker therapy for cardiac arrhythmia.Methods The authors analyzed the prognosis and risk factors among consecutive patients diagnosed cardiac device infection(CDI) at Fuwai hospital.All recruited patients were divided into recurrent group and non-recurrent group according to weather the recurrence of CDI after the first therapy to infection to analyze the risk factors of the recurrence of infection.Results A total of 52 patients with CDI identification were recruited in hospital from 2002 to 2008.53.9% of these infections were implanted dual-chamber pacemaker,and 30.8% combined diabetes mellitus.42.3% of the infections were diagnosed CDI over 1 year after last surgery;half of the infections were diagnosed after the first surgery.According to comparison analysis,those patients who suffered from CDI after the first surgery had more dual-chamber pacemaker implantation than that of the patients suffered from CDI after the second or following surgeries,but the above difference was still lower than the significant statistical benchmark.The removal of whole pacemaker system including leads(RR 0.11,95%CI,0.02-0.51,p<0.01) was approved the only factor related to the recurrence of CDI after the first debridement according to Logistic analysis.No patient died from CDI in this study.Conclusion It is the most effective treatment to remove pacemaker and leads weather the sac open to the air or not.