不同方法预防糖尿病患者起搏器囊袋感染的前瞻性研究
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摘要
目的评估在糖尿病患者起搏器植入术中使用4种不同方法处理起搏器囊袋,对预防起搏器相关感染的影响。方法将66例在单中心首次植入或更换起搏器患者,根据术中清理囊袋时使用方法的不同,按入选顺序随机分为A组(巴曲亭组,18例)、B组(庆大霉素组,15例)、C组(巴曲亭+庆大霉素组,17例)、D组(生理盐水对照组,16例)。术中在植入起搏器电池之前,分别用A、B、C、D 4种不同方法浸泡过的纱布清理囊袋。随访一个月,观察4种方法下感染的发生情况。结果 66例患者中,发生起搏器植入相关感染共5例,总发生率7. 6%,A、B、C、D四组分别为2例(11. 1%)、2例(13. 3%)、1例(5. 9%)和0例(0%)。对4组的感染率进行统计学分析,差异无统计学意义(P> 0. 05)。结论用巴曲亭、庆大霉素、巴曲亭+庆大霉素、生理盐水4种不同方法浸泡过的纱布清理囊袋,对预防糖尿病患者起搏器植入术后囊袋感染的发生无明显差异。
Objective To evaluate the influence of four different methods of treating pacemaker bag on preventing pacemaker-related infection during pacemaker implantation in diabetics. Methods A total of 66 patients with pacemaker first implanted or replaced in a single center were enrolled in our study. According to different methods of intraoperative bag cleaning and the order of selection,these patients were randomly divided into group A( hemo-coagulase group,18 cases),group B( gentamicin group,15 cases),group C( hemocoagulase plus gentamicin group,17 cases) and group D( normal saline group or control group,16 cases). During the operation,hospital gauze separately soaked in the four methods of A,B,C and D as used to clean the pacemaker bag before implanting pacemaker battery. The occurrences of bag infection were observed in the four methods during one-month follow-up. Results In the enrolled 66 patients,pacemaker-implantation-related infection occurred in 5 cases with a total incidence rate of 7. 6%. The number of infected cases was 2( 11. 1%),2( 13. 3%),1( 5. 9%) and 0( 0%) in the group A,B,C and D,respectively. The infection rate of the four groups did not vary significantly( P > 0. 05). Conclusion The efficacy of preventing bag infection after pacemaker implantation did not vary significantly with bag cleaned by hospital gauze separately soaked in the four methods of hemocoagulase,gentamicin,hemocoagulase plus gentamicin and normal saline.
Objective To evaluate the influence of four different methods of treating pacemaker bag on preventing pacemaker-related infection during pacemaker implantation in diabetics. Methods A total of 66 patients with pacemaker first implanted or replaced in a single center were enrolled in our study. According to different methods of intraoperative bag cleaning and the order of selection,these patients were randomly divided into group A( hemo-coagulase group,18 cases),group B( gentamicin group,15 cases),group C( hemocoagulase plus gentamicin group,17 cases) and group D( normal saline group or control group,16 cases). During the operation,hospital gauze separately soaked in the four methods of A,B,C and D as used to clean the pacemaker bag before implanting pacemaker battery. The occurrences of bag infection were observed in the four methods during one-month follow-up. Results In the enrolled 66 patients,pacemaker-implantation-related infection occurred in 5 cases with a total incidence rate of 7. 6%. The number of infected cases was 2( 11. 1%),2( 13. 3%),1( 5. 9%) and 0( 0%) in the group A,B,C and D,respectively. The infection rate of the four groups did not vary significantly( P > 0. 05). Conclusion The efficacy of preventing bag infection after pacemaker implantation did not vary significantly with bag cleaned by hospital gauze separately soaked in the four methods of hemocoagulase,gentamicin,hemocoagulase plus gentamicin and normal saline.
引文
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[14]Chang PM,Doshi RN.Implantation of a leadless cardiac pacemaker for recurrent pocket infections[J].Heart Rhythm Case Rep,2016,2(4):339-341.
[15]Nery PB,Fernandes R,Nair GM,et al.Device-related infection among patients with pacemakers and implantable defibrillators:incidence,risk factors,and consequences[J].J Cardiovasc Electrophysiol,2010,21(7):786-790.
[16]Klug D,Balde M,Pavin D,et al.Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators:results of a large prospective study[J].Circulation,2007,116(12):1349-1355.
[17]Landolina M,Gasparini M,Lunati M,et al.Long-term complications related to biventricular defibrillator implantation:rate of surgical revisions and impact on survival:insights from the Italian clinical service database[J].Circulation,2011,123(22):2526-2535.
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[19]Chua JD,Wilkoff BL,Lee I,et al.Diagnosis and management of infections involving implantable electrophysiologic cardiac devices[J].Ann Intern Med,2000,133(8):604-608.
[20]Gould PA,Gula LJ,Yee R,et al.Cardiovascular implantable electrophysiological device-related infections:a review[J].Curr Opin Cardiol,2011,26(1):6-11.
[21]Villamil Cajoto I,Rodríguez Framil M,Van den Eynde Collado A,et al.Permanent transvenous pacemaker infections:an analysis of 59 cases[J].Eur J Intern Med,2007,18(6):484-488.
[22]Bongiorni MG,Tascini C,Tagliaferri E,et al.Microbiology of cardiac implantable electronic device infections[J].Europace,2012,14(9):1334-1339.
[23]Morito N,Yamanouchi Y,Kodama S,et al.Orally administered levofloxacin as prophylaxis against pacemaker infection[J].Exp Clin Cardiol,2006,11(1):21-24.
[24]Nielsen JC,Thomsen PEB,Hjberg S,et al.A comparison of single-lead atrial pacing with dual-chamber pacing in sick sinus syndrome[J].Eur Heart J,2011,32(6):686-696.
[25]Tang AS,Wells GA,Talajic M,et al.Cardiacresynchronization therapy for mild-to-moderate heart failure[J].N Engl J Med,2010,363(25):2385-2395.
[26]Flaker GC,Theriot P,Binder LG,et al.Management of periprocedural anticoagulation:a survey of contemporary practice[J].J Am Coll Cardiol,2016,68(2):217-226.
[27]Douketis JD,Spyropoulos AC,Spencer FA,et al.Perioperative management of antithrombotic therapy:antithrombotic therapy and prevention of thrombosis,9th ed:American College of Chest of Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(Suppl 2):e326S-e350S.
[28]Healey JS,Eikelboom J,Douketis J,et al.Periprocedural bleeding and thromboembolic events with dabigatran compared with warfarin:results from the randomized evaluation of long-term anticoagulation therapy(RE-LY)randomized trial[J].Circulation,2012,126(3):343-348.
[29]Brignole M,Auricchio A,Baron-Esquivias G,et al.2013ESC guidelines on cardiac pacing and cardiac resynchronization therapy:the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology(ESC).Developed in collaboration with the European Heart Rhythm Association(EHRA)[J].Eur Heart J,2013,34(29):2281-2329.
[30]Beck H,Boden WE,Patibandla S,et al.50th Anniversary of the first successful permanent pacemaker implantation in the United States:historical review and future directions[J].Am J Cardiol,2010,106(6):810-818.
[2]Dernevik LC,Kennergren CE,Gabel JN.P-427 Infection rates after pacemaker operations and prophylaxis with gentamicin-collagen patches in the generator pocket[J].Europace,2003,4(Suppl 2):B167.
[3]Lopez JA.Conservative management of infected pacemaker and implantable defibrillator sites with a closed antimicrobial irrigation system[J].Europace,2013,15(4):541-545.
[4]Brignole M,Auricchio A,Baron-Esquivias G,et al.2013ESC guidelines on cardiac pacing and cardiac resynchronization therapy:the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology(ESC).Developed in collaboration with the European Heart Rhythm Association(EHRA)[J].Europace,2013,15(8):1070-1118.
[5]Durack DT,Lukes AS,Bright DK.New criteria for diagnosis of infective endocarditis:utilization of specific echocardiographic findings.Duke Endocarditis Service[J].Am JMed,1994,96(3):200-209.
[6]Choo MH,Holmes DR Jr,Gersh BJ,et al.Permanent pacemaker infections:characterization and management[J].Am J Cardiol,1981,48(3):559-564.
[7]Chamis AL,Peterson GE,Cabell CH,et al.Staphylococcus aureus bacteremia in patients with permanent pacemakers or implantable cardioverter-defibrillators[J].Circulation,2001,104(9):1029-1033.
[8]Sohail MR,Uslan DZ,Khan AH,et al.Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections[J].J Am Coll Cardiol,2007,49(18):1851-1859.
[9]Tracy CM,Epstein AE,Darbar D,et al.2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS2008 guidelines for device-based therapy of cardiac rhythm Abnormalities:a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines and the Heart Rhythm Society[J].J Am Coll Cardiol,2013,61(3):e6-e75.
[10]Brignole M,Auricchio A,Baron-Esquivias G,et al.2013ESC guidelines on cardiac pacing and cardiac resynchronization therapy:the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology(ESC).Developed in collaboration with the European Heart Rhythm Association(EHRA)[J].Eur Heart J,2013,34(29):2281-2329.
[11]Beck H,Boden WE,Patibandla S,et al.50th Anniversary of the first successful permanent pacemaker implantation in the United States:historical review and future directions[J].Am J Cardiol,2010,106(6):810-818.
[12]Mond HG,Proclemer A.The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators:calendar year 2009-a world society of arrhythmia's project[J].Pacing Clin Electrophysiol,2011,34(8):1013-1027.
[13]Polyzos KA,Konstantelias AA,Falagas ME.Risk factors for cardiac implantable electronic device infection:a systematic review and meta-analysis[J].Europace,2015,17(5):767-777.
[14]Chang PM,Doshi RN.Implantation of a leadless cardiac pacemaker for recurrent pocket infections[J].Heart Rhythm Case Rep,2016,2(4):339-341.
[15]Nery PB,Fernandes R,Nair GM,et al.Device-related infection among patients with pacemakers and implantable defibrillators:incidence,risk factors,and consequences[J].J Cardiovasc Electrophysiol,2010,21(7):786-790.
[16]Klug D,Balde M,Pavin D,et al.Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators:results of a large prospective study[J].Circulation,2007,116(12):1349-1355.
[17]Landolina M,Gasparini M,Lunati M,et al.Long-term complications related to biventricular defibrillator implantation:rate of surgical revisions and impact on survival:insights from the Italian clinical service database[J].Circulation,2011,123(22):2526-2535.
[18]HercéB,Nazeyrollas P,Lesaffre F,et al.Risk factors for infection of implantable cardiac devices:data from a registry of 2496 patients[J].Europace,2013,15(1):66-70.
[19]Chua JD,Wilkoff BL,Lee I,et al.Diagnosis and management of infections involving implantable electrophysiologic cardiac devices[J].Ann Intern Med,2000,133(8):604-608.
[20]Gould PA,Gula LJ,Yee R,et al.Cardiovascular implantable electrophysiological device-related infections:a review[J].Curr Opin Cardiol,2011,26(1):6-11.
[21]Villamil Cajoto I,Rodríguez Framil M,Van den Eynde Collado A,et al.Permanent transvenous pacemaker infections:an analysis of 59 cases[J].Eur J Intern Med,2007,18(6):484-488.
[22]Bongiorni MG,Tascini C,Tagliaferri E,et al.Microbiology of cardiac implantable electronic device infections[J].Europace,2012,14(9):1334-1339.
[23]Morito N,Yamanouchi Y,Kodama S,et al.Orally administered levofloxacin as prophylaxis against pacemaker infection[J].Exp Clin Cardiol,2006,11(1):21-24.
[24]Nielsen JC,Thomsen PEB,Hjberg S,et al.A comparison of single-lead atrial pacing with dual-chamber pacing in sick sinus syndrome[J].Eur Heart J,2011,32(6):686-696.
[25]Tang AS,Wells GA,Talajic M,et al.Cardiacresynchronization therapy for mild-to-moderate heart failure[J].N Engl J Med,2010,363(25):2385-2395.
[26]Flaker GC,Theriot P,Binder LG,et al.Management of periprocedural anticoagulation:a survey of contemporary practice[J].J Am Coll Cardiol,2016,68(2):217-226.
[27]Douketis JD,Spyropoulos AC,Spencer FA,et al.Perioperative management of antithrombotic therapy:antithrombotic therapy and prevention of thrombosis,9th ed:American College of Chest of Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(Suppl 2):e326S-e350S.
[28]Healey JS,Eikelboom J,Douketis J,et al.Periprocedural bleeding and thromboembolic events with dabigatran compared with warfarin:results from the randomized evaluation of long-term anticoagulation therapy(RE-LY)randomized trial[J].Circulation,2012,126(3):343-348.
[29]Brignole M,Auricchio A,Baron-Esquivias G,et al.2013ESC guidelines on cardiac pacing and cardiac resynchronization therapy:the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology(ESC).Developed in collaboration with the European Heart Rhythm Association(EHRA)[J].Eur Heart J,2013,34(29):2281-2329.
[30]Beck H,Boden WE,Patibandla S,et al.50th Anniversary of the first successful permanent pacemaker implantation in the United States:historical review and future directions[J].Am J Cardiol,2010,106(6):810-818.