钝性分离囊袋纤维网格对心脏起搏器更换术患者囊袋出血和感染的影响  

A reasonable management of pocket to control complications after cardiac pacemaker replacement

作　　者：彭晖[1] 马文英[1] 沈璐华[1] 

机构地区：[1]首都医科大学附属北京友谊医院,北京100050

出　　处：《中国心脏起搏与心电生理杂志》2014年第3期212-215,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的通过探讨不同时期起搏器更换术囊袋相关并发症的发生情况,总结更换起搏器的方法和临床经验,从而提高起搏器更换的安全性和有效性。方法回顾性分析2001年1月至2011年12月共10年间167例更换起搏器时局部囊袋处理方法的变化,即2008年以前原囊袋内周围形成的纤维网格不予以分开,仅在囊袋上部切口附近分离皮肤及组织,形成大小适中的囊袋;2008年以后尽量将原囊袋中形成的纤维网格分开,适当扩大原囊袋,并加强术后囊袋管理;同时观察起搏器更换术后囊袋感染和血肿的发生情况。结果 167例更换起搏器患者,均为起搏器电池耗竭;其中2008年1月以前更换者为77例,2008年1月以后更换者为90例。2个时间段,与起搏器囊袋并发症相关的患者和植入因素无显著不同,与2008年以前相比,2008年以后行起搏器更换术囊袋相关并发症发生率明显降低,差异有显著性(6.7%vs 27.3%,P<0.01),其中局部囊袋血肿10例(5.9%),8例(80%)为2008年以前更换,局部囊袋感染17例(10.2%),13例(76.5%)为2008年以前更换。结论起搏器更换术中将由结缔组织形成的原囊袋周围钝性分开的处理方法可降低起搏器更换术囊袋相关并发症发生。Objective To investigate the influence of operative methods and clinical experience on pacemaker pocket he- matoma and infection after pacemaker replacement, so as to provide basis for effective treatment. Method The data of 167 patients with pacemaker replacement were analysed retrospectively from Jan 1,2001 to Dec 12, 2011. The patients were divided into 2 groups according to the period （before Jan,2008 or after Jan,2008） and methods of operation on the pocket. Analysis of the relationship of different operative methods with the incidence of pocket hematoma and infection events. Results Battery depletion accounted for all patients of pacemaker replacement. There was no statistical difference in patient-related risk factors and procedural risk factors among 2 groups. The occurrence of haematoma and infection had significant difference among the 2 groups （ P= 0.027 ,P= 0.033, respectively ） ,the complications of haematoma accounting for 10.4% before 2008 and 2.2% after 2008, the complications of infection accounting for 16.9% before 2008 and 4.4% after 2008. Conclusions A reasonable operation（blunt dissection） of original pacemaker pocket may be a useful method away from the pocket complications.

关 键 词：心血管病学 心脏起搏器 更换术 感染 血肿 

分 类 号：R318.11[医药卫生—生物医学工程]