术前加用75%酒精擦拭皮肤对心血管植入式电子装置手术感染发生率的影响  

Effect of preoperative skin wiping with 75% alcohol on infections in cardiac implantable electronic device surgery

作　　者：黄克强 李继文[1] 刘志[1] 陈轶[1] 甘红梅 苏晞[1] 

机构地区：[1]武汉亚洲心脏病医院,湖北武汉430022

出　　处：《中国心脏起搏与心电生理杂志》2017年第6期515-519,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的比较心血管植入式电子装置术前加用75%的酒精擦拭皮肤和单纯用络合碘擦拭局部皮肤的感染发生率,探讨心血管植入式电子装置术前加用75%的酒精擦拭皮肤是否可减少感染的发生率。方法根据是否在术前进行局部酒精擦拭将本院4 322例心血管植入式电子装置的患者分为:单纯组和联合组。单纯组:术中单纯用络合碘消毒局部皮肤1 067例(2003年07月至2008年12月),联合组:术前用75%的酒精擦拭后术中再用络合碘消毒皮肤3 255例(2009年01月至2015年07月)。随访至少1年内所有患者是否发生器械植入相关的感染。比较两组局部皮肤处理方法的感染率、感染发生的时间及程度差异。结果两组患者的基线资料(肾功能损害、抗凝血药物使用、临时起搏等)无明显差异,两组患者的心血管植入式电子装置类型无明显差异,单纯组中共有18例(1.69%)发生感染,而联合组中共有6例(0.18%)发生感染。酒精擦拭组的早期感染发生率(0.03%vs 0.28%)、中期感染发生率(0.09%vs 0.47%)、延迟感发生率(0.03%vs 0.28%)及远期感染的发生率(0.03%vs 0.66%)均低于单纯组。感染组与未感染组在糖尿病、手术时间、是否酒精擦拭及CIED类型等方面有差异。结论术中常规络合碘消毒皮肤前加用75%的酒精擦拭可明显降低心血管植入式电子装置相关的感染发生率。Objective To evaluate whether additional preoperative skin wiping with 75% alcohol could reduce the incidence of cardiovascular implantable electronic devices（CIED）infection. Methods Consecutive 4 322 cases of CIED implantation or replacement were divided into just povidone-iodine group（July 2003-December 2008）with just povidone-iodine scrub and paint（n=1 067）and alcohol wiping group（January 2009-July 2015）with additional skin wiping with 75%isopropyl alcohol lasting for at least 5 minutes until removing dirt just before povidone-iodine scrub andpaint（n=3 255）.Compare the incidence of pocket infection,septicemia,and device extraction due to infection at least one year after implantation/replacement. Result There was no significant difference in background data of CIED infection risk factors identified by past studies（renal insufficiency,anticoagulant use,temporary pacing,generator replacement,and ICD implantation）between two groups.During the follow-up period,18 cases（1.69%）in just povidone-iodine group were confirmed CIED infection and 6 cases（0.18%））in alcohol wiping group.All the early infection incidence（0.03% vs 0.28%）,medium term infection incidence（0.09% vs 0.47%）,delayed infection incidence（0.03% vs 0.28%）and long-term infection rate（0.03% vs 0.66%）in alcohol wiping group were lower than just povidone-iodine group.There was a significant difference in body mass index,diabetes mellitus,operation time,alcohol wiping and CIED type between infected and uninfected groups. Conclusion Preoperative skin wiping with75% alcohol reduces infections in CIED surgery.

关 键 词：心血管病学 心血管植入式电子装置 酒精 络合碘 皮肤处理 感染率 

分 类 号：R318.11[医药卫生—生物医学工程]