23例心脏永久起搏器装置相关感染的临床特点与处理

目的探讨永久心脏起搏器装置相关感染的临床特征、治疗方法及其预后。方法选择2003年1月-2012年12月在兵团第六师医院、新源县人民医院、新疆医科大学第一附属医院心脏中心的2972例安装永久心脏起搏器装置病人，因“永久心脏起搏器装置相关感染”的有23例患者，回顾性分析永久心脏起搏器系统相关感染的临床特点、处理及预后。结果单纯囊袋局部感染21例，囊袋感染合并全身感染2例。2例经静脉使用抗生素及局部换药，3例行局部清创，18例行整个起搏装置移除与清创。局部清创组2例感染复发（66．7％），装置移除组1例感染复发（5．6％）。起搏器装置感染的发生率为0．77％，起搏器装置首次植入感染的发生率为0．69％，起搏器装置更换后的感染发生率为1．36％，首次植入起搏器患者感染发生率较起搏器更换患者低，差异无统计学意义（P=0．17）。结论永久心脏起搏器相关感染是起搏器植入后的严重并发症。单纯局部清创感染复发风险较高，永久起搏装置移除是最佳的治疗方案。

The clinical characteristics and treatment for pacemaker device-related infection in 23 patients

Objective To analyse retrospectively the clinical characteristics of cardiac pacemaker devices-related infections. Methods 23 patients who have cardiac pacemaker devices-related infections were enrolled in this retrospective study. Results Pocket infection in 21 cases, systemic infection in 2 cases. The incidence of pacemaker devices-related infection was 0.77%. The incidence of infection was 0.69% for the implant patients vs 1.36% for replacement patients, and there were significant differences in two groups （P =0.17）. For the treatment, 2 patients received only intravenous antibiotics and local treatment; 3 patients underwent local debridement; 18 patients removed and re-implanted pacemaker. There were 2 cases of recurrent infection （66.7%） in local debridement group and 1 case of recurrence in device removal group （5.6%）. Conclusion Pacemaker-related infection is a serious complication after implantation, and the best treatment for this situation is to remove the pacemaker device.