Satsu Takuma, Onoe Masahiko
Department of Cardiovascular Surgery, Kishiwada City Hospital, Osaka, Japan.
Pacing Clin Electrophysiol. 2010 Apr;33(4):426-30. doi: 10.1111/j.1540-8159.2009.02661.x. Epub 2009 Dec 16.
Although infection is a serious complication of pacemaker implantation, optimal treatment of infections related to pacemaker systems is poorly defined.
We describe a man in his 60s, an octogenarian, and two nonagenarian females who were treated for an infected permanent pacemaker. All of these patients developed inflammation that presented as local symptoms and purulent collection in the pockets of their implanted pacemakers. After fenestration of the pacemaker pockets, they were treated with vacuum-assisted wound closure (VAC).
Infection was eradicated in all the patients without the need for aggressive surgery. The open wound was re-sutured without complete removal of the pacemaker system in two patients. After removing the infected generator from the other two patients, the open wounds healed with or without re-suture. The mean duration of VAC was 19.5 days. The postoperative course of all of the patients was uneventful, and they remained completely asymptomatic after VAC, with no evidence of recurrent infection for 5- 15 months after discharge.
When the risk of total system explantation is high, less-invasive VAC might serve as the option for treating an infected pacemaker. (PACE 2010; 426-430).
尽管感染是起搏器植入的一种严重并发症，但对于与起搏器系统相关感染的最佳治疗方法尚无明确界定。
我们描述了一名60多岁的男性、一名80多岁的老人和两名90多岁的女性，他们因永久性起搏器感染而接受治疗。所有这些患者均出现炎症，表现为局部症状以及植入起搏器囊袋内有脓性分泌物。在对起搏器囊袋进行开窗术后，他们接受了负压封闭引流（VAC）治疗。
所有患者的感染均被根除，无需进行激进手术。两名患者在未完全移除起搏器系统的情况下对开放伤口进行了重新缝合。在从另外两名患者身上移除感染的发生器后，开放伤口愈合，有的进行了重新缝合，有的未进行重新缝合。VAC的平均持续时间为19.5天。所有患者的术后病程均平稳，在VAC治疗后他们完全无症状，出院后5至15个月无复发感染迹象。
当整个系统取出的风险较高时，侵入性较小的VAC可能是治疗感染起搏器的一种选择。（《心律》2010年；426 - 430页）
