心律植入装置迟发感染的临床分析  

Clinic Analysis of Late Infection in Patients Undergoing Implantation of Cardiac Implantable Electronic Device

作　　者：冯天捷[1] 翁思贤 周彬 董潇男 于丰源[1] 任晓庆[1] 华伟[1] 唐闽 FENG Tian-jie;WENG Si-xian;ZHOU Bin;DONG Xiao-nan;YU Feng-yuan;REN Xiao-qing;HUA Wei;TANG Min(Department of Arrhythmia Center,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心律失常中心,北京市100037

出　　处：《中国分子心脏病学杂志》2021年第1期3692-3696,共5页Molecular Cardiology of China

基　　金：国家自然科学基金(61527811)。

摘　　要：目的探讨心律植入装置(cardiac implantable electronic device,CIED)迟发感染的危险因素和临床情况。方法选择2016年1月至2019年6月在阜外医院心律失常中心某病区接受永久起搏器植入手术的3547例患者。根据是否发生感染分为感染组(70例)和非感染组(3477例)。回顾性调查术后1年以上囊袋感染的发生情况,相关危险因素及临床处理。结果CIED迟发囊袋感染发生率1.97%。多因素回归分析显示:迟发感染与植入时间(OR=1.059,95%CI:1.031-1.088,P<0.01),与患者年龄相关(OR=1.049,95%CI:1.008-1.191,P=0.02),手术次数(OR=1.132,95%CI:1.021-3.258,P=0.01),是否植入临时起搏器(OR=0.241,95%CI:0.064-0.913,P=0.036),上一次手术住院时间(OR=3.457,95%CI:1.979-6.039,P<0.01)相关;是影响心律植入装置迟发囊袋感染的独立危险因素(P<0.01)。ROC曲线显示:感染组患者危险因素的最佳截断值:年龄59岁,植入时间13.5个月,接受1.8次手术,住院时间2.5天。结论感染危险因素提示需要做好相关预防措施,移除脉冲发生器和电极导线拔除是严重迟发CIED感染的有效治疗方式。Objective To explore the clinical characteristics of the infections in patients undergoing implantation of permanent pacemaker after one year.Methods A total of 3547 patients with implantation of cardiac implantable electronic device(CIED)who was treated from January 2016 to June 2019 were recruited as study objects and divided into infection group(n=70)and non-infection group(n=3477).The data of signs and laboratory examination indicators were observed and compared between the two groups before and after the treatment.Results The rate of delay infection of CIED implantation was 1.97%.The multivariate logistic regression analysis showed that the risk factors for the postoperative infections in the patients with CIED included the time of implantation(OR=1.059,95%CI:1.031-1.088,P<0.01),the age of patients(OR=1.049,95%CI:1.008-1.191,P=0.02),the number of operation(OR=1.132,95%CI:1.021-3.258,P=0.01),whether receiving temporary pacemaker(OR=0.241,95%CI:0.064-0.913,P=0.036),and the length time of last operation in hospital(OR=3.457,95%CI:1.979-6.039,P<0.01).ROC curve analysis indicted that the best cutoff points for risk factors for infection were 59 years old,13.5 months of implantation,1.8 times of operation,and 2.5 days in hospital respectively.Conclusion The risks of delay infection for CIED were the time of implantation,the age of patients,the number of operation,whether receiving temporary pacemaker,and the length time of last operation in hospital.Removal of the pacemaker is an effective way to treat postoperative infections.

关 键 词：心律植入装置 感染 影响因素 

分 类 号：R541.7[医药卫生—心血管疾病]