负压创面治疗技术在起搏器囊袋感染治疗中的临床应用  

Clinical application of negative pressure wound therapy in the treatment of pacemaker pocket infection

作　　者：郑胜武[1] 黄雄梅 林亚洲 庄兢[1] 林根辉[1] ZHENG Sheng- wua;HUANG Xiong-meia;LIN Ya-zhoub;ZHUANG Jinga;LIN Gen-huia(a Department of Plastic Surger;b Fu- jian Heart Disease Research Institute, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001,Fujian, Chin)

机构地区：[1]福建医科大学省立临床医学院福建省立医院整形外科,福建福州350001 [2]福建医科大学省立临床医学院福建省立医院福建省心血管病研究所,福建福州350001

出　　处：《中国心脏起搏与心电生理杂志》2018年第1期61-65,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨负压创面治疗技术(NPWT)用于治疗心脏起搏器囊袋感染的有效性及安全性。方法 2013年1月至2016年5月收治心脏起搏器囊袋感染患者15例,根据NPWT原理,一期清创后囊袋内放置负压引流系统,封闭创面后持续负压(300~400mmHg)引流5~7d,二期将起搏器重置深埋于胸大肌后间隙并闭合创面,保留原心脏起搏器系统。结果术后随访5~37个月,平均随访时间18.2个月,其中14例起搏器囊袋感染治愈,伤口愈合良好,随访期内未发现感染复发。1例血培养阳性患者前后经过3个疗程的NPWT治疗,感染仍无法控制,最终移除感染侧整套起搏器装置,并在对侧植入新的起搏器系统后治愈。结论在严格选择适应证的前提下,NPWT是一种可行的治疗血培养阴性、非感染性心内膜炎的单纯心脏起搏器囊袋感染的新方法。Objective To investigate the effectiveness and safety of the treatment of cardiac pacemaker pocket infection using negative pressure wound therapy （NPWT）. Methods From January 2013 to May 2016, 15 patients with cardiac pacemaker pocket infection were treated with NPWT. In the first stage, the negative pressure drainage system was placed in pacemaker pocket after debridement , then NPWT was used to seal the wound and the negative pressure （300--400 mmHg） was sustained for 5-7days. In the second stage, the pacemaker was resettled to the posterior pectoralis major and the wound was closed. Thus the original pacemaker system was remained. Results 14 of 15 patients with pacemaker pocket infection who received NPWT treatment were healed without recurrence during a follow-up period for 5-37 months, the mean follow-up time was 18.2 months. One patient whose blood germiculture was positive received 3 courses NPWT treatment, it was still unable to control the infection. Eventually, the whole original pacemaker system was removed and a new pacemaker was implanted in the contralateral chest wall. Conclusion On the premise of strict selected indications, NPWT is a new treatment for blood germiculture negative, non-infective endocarditis patients with pacemaker pocket infection, it is feasible and deserves further exploration and promotion.

关 键 词：心血管病学 起搏器 囊袋感染 治疗 负压创面治疗技术 

分 类 号：R318.11[医药卫生—生物医学工程]