永久性心脏起搏器囊袋破溃的临床表现和处理  

Clinical manifestations and management of pacemaker pocket rupture

作　　者：孙泽琳[1] 谢启应[1] 杨天伦[1] 蒲晓群[1] 李传昶[1] 邓金华[1] 孟霜媛[1] 

机构地区：[1]中南大学湘雅医院心内科,湖南长沙410008

出　　处：《中国现代医学杂志》2015年第8期76-79,共4页China Journal of Modern Medicine

摘　　要：目的分析永久性心脏起搏器术后囊袋破溃患者的临床表现和处理方法,总结处理此并发症的有效方法。方法回顾性分析1999年1月-2014年7月因永久性心脏起搏器植入或更换术后囊袋破溃在该院行囊袋处理的患者13例。结果 2 145例患者在该院行永久性心脏起搏器植入或更换,其中10例患者术后出现起搏器囊袋破溃并感染,发生率为0.47%;另有3例外院患者在起搏器植入术后出现囊袋破溃转入该院进一步处理,共计13例患者。7例患者行囊袋处分泌物培养均为阴性。囊袋破溃原因考虑为感染所致,所有患者均予以局部清创,移除脉冲发生器。除1例患者拔除起搏电极,其余患者剪除多余电极后将导线残端局部包埋,延时或当时在对侧前上胸植入永久性心脏起搏器,同时静脉使用抗生素。术后随访2~74个月,平均（38.2±23.0）个月,1例患者出现感染性心内膜炎;2例患者术后再次出现囊袋破溃,经再次处理后未出现囊袋破溃现象。结论感染是永久性心脏起搏器术后并发囊袋破溃最常见的原因。有效的抗生素治疗和局部彻底清创,将原脉冲发生器取出而保留电极导线残端可安全、有效的处理此并发症。[ Objective] To evaluate the clinical manifestations and the causes of pacemaker pocket rupture and the methods of treatment. [Methods] A retrospective study was performed in 13 patients who had pacemaker pocket rupture between January 1999 and July 2014. And the clinical manifestations and treatment methods of pacemaker pocket rupture were carefully analyzed. [Results] Among the 13 cases enrolled in this study, germ culture of the secretion around the pockets and antibiotic susceptibility testing were performed in 7 cases and the result was negative. However, infection was the cause of pocket rupture in all the patients. Methods including antibiotic treatment plus debridement, irrigation, removing the pacemaker pulse generators, then implanting them at the opposite sites were performed in all the patients. Pacing electrode was preserved in the patients, but extraction was performed in one patient when the pocket rupture was recovered and vegetation was found by transthoracic echocardiography. And pacemaker pulse generator was placed under the eetopectoralis in one patient when pocket rupture was recovered during the follow-up for 2- 74 months [averaging （38.2±23.0） months]. [Conclusion] Pacemaker pocket infection is the chief cause of pacemaker pocket rapture. Proper methods including antibiotic treatment plus debridement, irrigation, etc, may be effective in most of the patients.

关 键 词：永久性心脏起搏器 囊袋破溃 临床表现 保留电极残端 

分 类 号：R541.7[医药卫生—心血管疾病]