摘要
目的探讨起搏器置入术后,起搏器外露和置入部位感染的原因及处理方法。方法起搏器外露,则先行分泌物培养加药敏;置入处感染但无起搏器外露,则术中取分泌物并行培养加药敏实验。术中自原切口切开皮肤,清除感染外露处坏死的皮肤,并将起搏器取出,浸泡在碘伏溶液中。同时,清除导线周围及起搏器腔隙中感染的肉芽组织及增生的纤维组织,用双氧水、碘伏、甲硝唑反复冲洗腔隙后,重新消毒。在原切口下,顺胸大肌的肌纤维走形方向,将肌纤维分开,在胸大肌下、胸小肌上形成足够容纳起搏器的新腔隙,重新置入起搏器,在新腔隙及原腔隙内各放置二根引流管,术后敏感抗生素持续滴注引流7～10天。结果本组23例,经上述处理,19例伤口愈合。4例未愈,经再次处理,伤口愈合。12例3～6个月后复诊无感染及起搏器再次外露。结论起搏器外露和置入处感染,经彻底清创,重新置入胸大肌下及术后敏感抗生素滴注引流是可以治愈的。
Objective To investigate the cause and management of pacemaker pocket infection and exposure. Meth- ods Secretion from the site of exposure or the wound bed was cultured and performed antibiotic sensitivity preoperatively or intraoperatively. Surgical incision into the pocket was performed form the original incision site, infection and necrosis skin was excised, pacemaker was taken out and sterilized by Iodine. Meanwhile, infected granulation tissue and hyperplastic fi- brous tissue around the pacemaker wires or inside the pocket were also cleared out. After the pocket was washed by hydro- gen peroxide, Iodophors and metronidazole solution, the operation site was resterilized and draped. At the original incision, the musculus pectoralis major was divided along the fiber, and a new pocket was implanted between the musculus pectoralis major and minor. The pacemaker was inserted into the new pocket. Each two suction drainages were put inside the old and new pockets. The sensitive antibiotic irrigated along the catheters about seven to ten days postoperatively. Results Twenty-three cases in this group were treated by using this above technique, nineteen were treated successfully, four of them were treated again and cured. Following up 3 - 6 months, twelve cases were cured with no recurrence of infection and pacemaker exposure. Conclusion By a series treatment, pacemaker infection and exposure can be treated successfully.
出处
《中国心脏起搏与心电生理杂志》
北大核心
2011年第6期506-507,共2页
Chinese Journal of Cardiac Pacing and Electrophysiology
关键词
心血管病学
起搏器
外露
感染
治疗
Cardiology
Pacemaker
Infection
Exposure
Treatment
