埋藏式心脏起搏器致局部感染6例分析

我院自1982年3月至1985年7月为患者安置埋藏式人工心脏起搏器共65例次,其中6例,9次于埋藏起搏器后软组织部位发生化脓性感染。本文对感染原因及治疗进行分析讨论。临床资料在发生埋藏起搏器局部感染的6例中,男性3     

埋藏式心脏起搏器植入术后并发症的观察与护理体会

目的 探讨埋藏式起搏器植入术后并发症的护理问题.方法 对2007-07～2009-12共68例行埋藏式起搏器植入术后患者的护理情况进行回顾性总结.结果 7例术后发生出血、血肿、起搏器囊袋感染、电极移位等并发症,经妥善的护理,取得较好效果.结论 进行埋藏式起搏器植入术不可避免发生相关的并发症,加强护理可预防和减轻血肿、起搏器囊袋感染等并发症的发生.     

全皮下埋藏式心律转复除颤器发展现状

全皮下埋藏式心律转复除颤器为全皮下植入ICD,可以避免静脉导线相关的并发症,减少感染风险。本文就全皮下埋藏式心律转复除颤器发展现状作一综述。     

起搏导管脱人心脏感染致死一例

患者男性,59岁。因于1988年9月在院外安装埋藏起搏器,术后感染反复发热加重两个月,1991年2月10日来我院急诊。1981年因心悸,在当地医院诊断为“病态窦房结综合征”。1988年9月安装永久埋藏起搏器(型号不详),右肩关节前窝切口,作起搏器(?)袋。术后局部感染反复发热,曾两次局部清创处理。     

血管内反推力牵引法取出起搏器电极导管治疗起搏器系统感染的评价

随着置入性起搏器和埋藏式心律转复除颤器在临床广泛应用,导线感染、断裂等严重并发症的根本处理方法是将整根导线取出体外.     

并发症及死亡情况分析

928例次埋藏式起搏器治疗中发生的主要并发症为电极脱位、感染、起搏器综合征、腹痛。死亡患者多患有严重基础心脏病,主要死因为心室纤颤和充血性心力衰竭。     

体内双ⅤⅥ型起搏器起搏心电图1例

患者男性,65岁。埋藏心脏起搏器5年后局部感染,被迫更换部位,重新安置起搏器。因患者高度依赖人工起搏,故先安新机,再拆除旧机。     

起搏器术后感染的识别和处理

近年来心脏起搏器及埋藏式心脏转复除颤器功能日益完善,技术逐渐成熟,但术后感染作为一个较常见且严重的并发症,一直是术者非常关注的问题。多数文献报道术后感染多来源于囊袋局部皮肤污染,多为葡萄球菌感染。预防性应用青霉素类抗生素可降低术后感染的发生。感染一旦发生应根据情况尽快处理,拔除起搏系统并联合静脉应用抗生素,避免发生更加严重的后果。     

起搏器反复感染后原起搏器再植入的护理支持

从1958年第一台埋藏式人工心脏起搏器植入人体开始,经过半个世纪,全世界植入心脏起搏器的患者已经超过300万人。植人人工心脏起搏器用来治疗缓慢型心律失常已经成为临床上常规使用的治疗技术,这是一种有创的治疗技术。植入永久起搏器术后感染的发生率为0．5％～5％,平均为2％。起搏器感染是一种较为常见而又比较难处理的并发症,     

心脏复律除颤器植入术中除颤阈值测试的现代观点

早期埋藏式心脏复律除颤器装置可靠性差,除颤失败率高,对快速的室性心律失常（室性心动过速）或心室颤动事件唯一的治疗方法是电击;因此在植入埋藏式心脏复律除颤器时常规进行除颤阈值测试。现代埋藏式心脏复律除颤器的性能较前明显改善,除颤性能提高,经静脉途径植入埋藏式心脏复律除颤器的平均除颤阈值是20～30J,低于埋藏式心脏复律除颤器最大输出能量,且除颤阈值测试可给患者带来一定的危险;因此许多临床心脏电生理学者开始质疑埋藏式心脏复律除颤器植入术中除颤阈值测试的价值。     

永久性心脏起搏器植人术后感染患者的临床资料分析

目的回顾性分析永久性心脏起搏器植入术后感染患者的临床特点,并对不同治疗方法进行评价。方法纳入2005年8月~2013年3月植入心脏起搏器[包括双腔及三腔起博器（CRT）]后发生感染的患者12例,分析感染者的临床特点,同时比较不同抗感染治疗（包括抗生素＋局部换药;抗生素＋原囊袋清创消毒＋起搏器原侧换位植入;起搏器及导线拔除＋抗生素＋起搏器对侧植入）方案的疗效差异。结果12例患者中植入双腔起搏器11例（91.6%）,CRT 1例（8.3%）,感染出现的中位时间为4.5个月,平均随访（33.0±19.0）个月。12例患者中有10例（83.3%）患者合并1种或以上其他疾病（包括糖尿病、心功能不全、慢性阻塞性肺病、结缔组织病等）,4例（33.3%）患者体内有2根以上的电极导线。10例首选保守治疗（应用抗生素＋局部换药,或抗生素＋原囊袋清创消毒＋起搏器原侧换位置入）中有8例感染复发,其中6例通过去除整个起搏系统治愈,1例起搏器消毒后重新置入治愈,1例形成窦道持续换药;2例首选去除起搏系统的患者均痊愈。结论起搏器感染多发生在合并危险因素的患者,一旦感染累及起搏系统,去除整个起搏系统是合理的。     

Pacemaker infection due to Aspergillus: report of two cases and literature review

BACKGROUND: Aspergillus infections of pacing systems are extremely uncommon, and most cases reported are characterized by an aggressive behavior that may lead to death of the patient. HYPOTHESIS: The study was undertaken to assess the incidence of pacemaker infection due to Aspergillus in a defined population. METHODS: A retrospective review of the case histories of all patients who underwent pacemaker implantation in the reference center for a defined population over a 13-year period was undertaken. A literature review of pacemaker infections due to Aspergillus was conducted. RESULTS: Of the 1,321 patients who required pacemaker implantation at Hospital Xeral-Calde in the Lugo region of northwestern Spain, 38 suffered a pacemaker infection. A pacemaker pocket infection due to Aspergillus fumigatus was found in two patients. Both patients had a previous history of diabetes mellitus. Cultures from pacemaker pocket inflammatory fluid yielded positive results. Following pacemaker explantation and antifungal therapy, clinical improvement was achieved. A literature review showed another five cases of pacemaker infection due to Aspergillus. However, two peculiarities were found in our patients: In both cases an etiological diagnosis was achieved prior to surgery and, to the best of our knowledge, they also constitute the first cases of pacemaker pocket infection due to Aspergillus. CONCLUSION: Although pacemaker infections due to Aspergillus species are uncommon, they should be considered in immunocompromised patients.     

心脏起搏器相关难治性感染的处理

目的总结难治性心脏起搏器相关感染的临床表现和外科处理经验,以提高此类感染的治愈率。方法分析北京大学人民医院收治的难治性起搏器相关感染病例住院及随访资料。难治性感染是指经清创术后复发,经久不愈;心腔内感染;合并其他并发症。结果13年共收治17例,其中13例局部感染,4例感染性心内膜炎,经综合治疗及外科处理,甚至开胸取出电极导线,17例均治愈出院。结论难治性起搏器相关感染正确的外科干预十分重要,包括局部清创、彻底去除起搏系统,甚至心脏直视手术。     

Transvenous pacemaker malposition in the systemic circulation and pacemaker infection: a case report and review of the literature

Transvenous pacemaker malposition in the systemic circulation is a rare complication of pacemaker implantation; the incidence is not well known. However, with the aid of two-dimensional echocardiography, the problem of pacemaker malposition can be identified earlier. After pacemaker insertion, an electrocardiogram and a posterior-anterior and lateral chest x-ray should be routinely performed. In difficult cases, transthoracic echocardiography and transesophageal echocardiography can be helpful for better visualization and confirmation of the malposition of the pacemaker lead(s). Pacemaker infection is another complication. A case of pacer lead malposition into the left ventricle through a sinus venosus atrial septal defect and superimposed infection is reported, and the management of endocardial lead malposition in the systemic circulation and pacemaker infection is reviewed.     

老年患者永久起搏器植入术中抗生素冲洗囊袋对囊袋感染发生率的影响

目的了解使用抗生素液冲洗起搏器囊袋对囊袋感染的预防作用。方法122例患者分为抗生素囊袋预防组和生理盐水对照组,两组手术操作相同,术后经静脉使用抗生素7d,第7天拆线。术后1、3、6、12月、3年常规随访,观察手术切口及囊袋情况。结果两组各有1例于术后第4天和第7天发生囊袋感染,两组囊袋感染发生率无显著差别。结论在老年患者永久起搏器植入术中,使用抗生素冲洗囊袋对囊袋感染发生率无明显影响。     

A patient with relapsing pacemaker infection due to "Gram-positive bacilli"

Mycobacterium fortuitum infection of pacemaker system is rarely encountered in clinical practice. We reported a case of relapsing M. fortuitum infection of pacemaker system associated with endocarditis which had been erroneously diagnosed to be Gram-positive bacilli. The diagnosis was finally confirmed by detail histological and microbiological examination. This case clearly demonstrated that incomplete removal of pacemaker system resulted in relapsing infection despite appropriate antibiotic therapy.     

Intracolonic migration of a pacemaker generator

Following pacemaker implantation, a 75-year-old male developed a low grade infection of the generator pocket. Utilizing the same generator, several relocations of the generator were made with the result that eventually the pacemaker, eroding the muscular planes, found his way into the ascending colon. Healing could be achieved only after removing the whole pacemaker system. The authors' current policy in case of pacemaker infection is also reported.     

糖尿病肾病合并起搏器感染、胸骨后脓肿及感染性心内膜炎1例

糖尿病伴多器官并发症的诊治复杂,同时合并心血管疾病、肾脏病及起搏器感染等更为困难。本文报道1例患有糖尿病肾病、肾功能不全、陈旧性心肌梗死、糖尿病足、脓毒血症、起搏器感染、胸骨后脓肿、骨髓炎和感染性心内膜炎的病例,经肾脏替代治疗(RRT)、足部清创换药、拔除起搏器和足疗程抗生素后治疗病情好转。本病例的诊治提示我们糖尿病肾功能衰竭合并起搏器感染患者要及时拔除起搏器并应用足量敏感抗生素,早期RRT或可使患者获益。     

Pacemaker related endocarditis: analysis of seven cases

Vegetative electrode infection following permanent pacemaker implantation is a rare and serious complication. Among 1920 patients who underwent permanent pacemaker implantation in our institute between 1980 and 2000, 7 patients aged 65 to 78 years were diagnosed to have pacemaker related endocarditis. In this study, the clinical course and management strategies for these patients are reviewed. The most frequently encountered factors contributing to development of pacemaker infection were local complications such as postoperative hematoma and inflammation, and recurrent surgical interventions on the pacemaker system. In blood cultures S. aureus was the most common causative microorganism. Echocardiography could be performed in 5 patients. Three patients were referred to open-heart surgery for total removal of the pacemaker system, and one patient had his pacemaker system removed percutaneously. The remaining 3 patients did not agree to either surgical or percutaneous removal. These patients have been under antibiotic therapy for approximately 3 years and they still do not have any signs of a serious infection. Consequently, in patients with permanent pacemakers, infective endocarditis should be considered in the presence of fever and local symptoms. Blood cultures should be obtained and echocardiography should be performed. Complete removal of the pacemaker system with intensive antibiotic treatment is necessary for complete eradication of the infection. However, if percutaneous or surgical removal of the electrodes cannot be done because of high perioperative risk or the patient does not agree to undergo either method, medical treatment with long term antibiotic use may be considered as an alternative.     

Extraktion einer infizierten Schrittmacherelektrode mittels Lasersheath

A case of pacemaker electrode infection with Staphylococcus aureus is presented. In order to avoid sternotomy, the right ventricular pacemaker lead, which had been implanted for 15 years, was successfully extracted using a laser sheath despite large endocarditic vegetations on the pacemaker lead. After completion of a 6-week course of antibiotics, the patient was discharged without any further evidence of infection.