Graux P, Lequeuche B, Guyomar Y, Carlioz R, Delfaut P, Beaugeard D, Noël A M, Dutoit A
Service de Cardiologie, CH Saint-Philibert, Lomme.
Ann Cardiol Angeiol (Paris). 1996 Mar;45(3):113-8.
Infections after cardiac pacemaker implantation are rare (0.13 to 12.6%) but potentially severe complications. Staphylococcus is the genus most frequently isolated (72 to 100% of cases). The use of systematic prophylactic antibiotics remains controversial. From November 1991 to October 1993, 207 consecutive patients were submitted to a series of measures designed to reduce the risk of infection: a) intravenous bolus injection of Cefamindole, 15 minutes before implantation, b) cutaneous disinfection with iodinated polyvindone, c) injection of an ampoule of rifampin before closure of the pacemaker in the pouch, d) absence of drainage system. Patients were predominantly female (60.9%), with a mean age of 77 +/- 10 years, frequently suffering from heart disease (53.8%). The indication for implantation was atrioventricular block (39.7%), carotid sinus syndrome (27.5%), atrial arrhythmia (27.5%), resection of the node-His tract (5.3%). This procedure corresponded to the first implantation in 88.4% or replacement of a previous pacemaker in 11.6% of cases and the pacing mode was single-chamber (38.4% or replacement of a previous pacemaker in 11.6% of cases and the pacing mode was single-chamber (38.7%), or double chamber (61.3%). The mean duration of the procedure was 51.5 min +/- 30 min. The mean follow-up was 12.7 +/- 5 months. The overall mortality was 14% (11 cases of cardiac failure, 6 sudden deaths, 4 cerebrovascular accidents, 4 cases of pneumonia, 4 neoplasms). Only one infectious problem (endocarditis, i.e. 0.48%) was observed.
心脏起搏器植入术后感染虽罕见（发生率为0.13%至12.6%），却是潜在的严重并发症。葡萄球菌是最常分离出的菌属（占病例的72%至100%）。系统性预防性使用抗生素仍存在争议。1991年11月至1993年10月，连续207例患者接受了一系列旨在降低感染风险的措施：a）植入前15分钟静脉推注头孢孟多；b）用聚维酮碘进行皮肤消毒；c）在起搏器囊袋关闭前注射一支利福平；d）不设引流系统。患者以女性为主（占60.9%），平均年龄77±10岁，常患有心脏病（占53.8%）。植入指征为房室传导阻滞（占39.7%）、颈动脉窦综合征（占27.5%）、房性心律失常（占27.5%）、结希氏束切除（占5.3%）。该手术在88.4%的病例中为首次植入，在11.6%的病例中为更换先前的起搏器，起搏模式为单腔（占38.7%）或双腔（占61.3%）。手术平均时长为51.5分钟±30分钟。平均随访时间为12.7±5个月。总死亡率为14%（11例心力衰竭、6例猝死、4例脑血管意外、4例肺炎、4例肿瘤）。仅观察到1例感染问题（心内膜炎，即0.48%）。
