老年患者永久性心脏起搏器植入术后医院感染的临床研究  

Clinical study of hospital infections after permanent pacemaker implantation in elderly patients

作　　者：施胜铭[1] 吴费凯[1] 温晓红[1] 王彬辉[2] 刘燕[1] 

机构地区：[1]湖州市第一人民医院心内科,浙江湖州313000 [2]浙江省台州学院医学院附属市立医院药剂科,浙江台州318000

出　　处：《中华医院感染学杂志》2015年第14期3266-3267,3279,共3页Chinese Journal of Nosocomiology

基　　金：浙江省中医药科学研究基金项目(2011ZB160)

摘　　要：目的探讨老年患者永久性心脏起搏器植入术后医院感染的临床表现、处理及转归研究,为临床诊断治疗提供参考。方法回顾性分析2008年3月-2013年12月起搏器植入术后发生医院感染的老年患者32例临床资料,分析患者感染发生率、临床表现、术后并发症、感染病原菌等,处理方法为双腔起搏者电极分别固定于患者的右室心尖部与右心耳,单腔起搏电极固定于患者右室心尖部。结果在医院接受起搏器植入术的患者589例中发生医院感染32例,感染率为5.43%,其中,单腔起搏器植入患者8例占25.00%,双腔起搏器植入患者24例占75.00%;感染部位主要为肺部、泌尿系统、切口及囊袋,分别占65.63%、18.75%、9.73%及6.25%;32例感染患者送检标本共分离出病原菌35株,主要为肺炎克雷伯菌、大肠埃希菌、金黄色葡萄球菌,分别占48.57%、31.43%、2.86%;32例患者中5例发生并发症,发生率为15.62%。结论老年性永久性心脏起搏器植入术后医院感染患者必须做好预防措施,应采取积极有效地抗菌药物全身治疗,具有重要临床意义。OBJECTIVE To discuss the clinical manifestations,treatment and outcomes of hospital infections after permanent pacemaker implantation in elderly patients,so as to provide a reference for clinical diagnosis and treatment.METHODS Clinical data of 32 elderly patients who had hospital infections after pacemaker implantation during Mar.2008 to Dec.2013 were retrospectively analyzed.The incidence of infections,clinical manifestations,postoperative complications and infectious pathogens were analyzed.In the treatment,electrodes of the dual-chamber pacemaker were fixed on the patient＇s right ventricular apex and right atrial appendage,and electrodes of single-chamber pacemaker on the right ventricular apex.RESULTS Totally 32 out of the 589 patients who received pacemaker had hospital infections,the infection rates was 5.43%,including 8patients who received single-chamber pacemaker（25.00%）and 24 patients who received dual-chamber pacemaker（75.00%）.The main infected sites were lungs,urinary system,incisions and capsular sac,accounting for 65.63%,18.75%,9.73%,and6.25%.From the specimens of 32 infected patients,35 pathogenic strains were detected,including Klebsiella pneumoniae,Escherichia coli,and Staphylococcus aureus,accounting for 48.57%,31.43%,and 2.86%.Totally 7out of the 32 patients had complications with the incidence rate of 21.88%.CONCLUSIONFor elderly patients who had hospital infections after permanent pacemaker implantation,clinicians should take preventive measures forehead and active and effectively systemic treatment with antibiotics which has important clinical significance.

关 键 词：永久性心脏起搏器 植入 医院感染 临床表现 

分 类 号：R619[医药卫生—外科学]