心脏植入电子装置感染的相关危险因素分析

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摘要目的：确定心脏植入电子装置（cardiovascular implantable electronic device，CIED)感染的发生率，分析感染的相关危险因素。方法：回顾性统计分析2000年1月-2012年12月13年间，本心脏中心植入起搏器和除颤仪出现的CIED感染病例。分析研究这些病例的临床表现和基础疾病特征，评估感染的相关危险因素。结果：共植入CIED[永久起搏器，心脏再同步治疗（CRT）和埋藏式心脏转复除颤仪（ICD）]1 817例（男:女=1.4:1），其中16例（男:女=3:1）发生CIED感染，发生率为0.9%。15例（占93.8%）确定为起搏器囊袋感染。68.8%检测到细菌，90.9%为凝固酶阴性葡萄球菌。显著相关的危险因素是植入ICD/CRT-D（P=0.000）、合并糖尿病（P=0.009）和合并甲状腺功能低下（P=0.000），其发生CIED感染的相对危险度（OR）分别为9.12、4.18和37.55。而起搏器更换未增加发生CIED感染的风险（P＞0.05）。男性CIED感染者的体质量指数，尤其是非糖尿病男性CIED感染者，显著低于非CIED感染男性（P＜0.05）。结论：本中心CIED感染率为0.9%，绝大多数表现为囊袋感染，以凝固酶阴性葡萄球菌感染为主。植入ICD/CRT-D、合并糖尿病和合并甲状腺功能低下是CIED感染的相关危险因素；低体质量指数男性容易发生CIED感染。

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	方丹红
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	黄伟剑

关键词 ：心脏植入电子装置, 感染, 凝固酶阴性葡萄球菌, 体质量指数

Abstract：Objective: To determine the the incidence of infection in cardiovascular implantable electronic device (CIED) in our heart centre, and analyse the risk factors associated with infection. Methods: Thirteen years (2000-2012) of cases of CIED infection were analyzed retrospectively. The clinical presentation and base characteristics of these patients were analyzed, risk factors associated with infection were assessed. Results: 1 817 cases (male:female=1.4:1) were implanted cardiac electronic device [permanent pacemakers, cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillator (ICD)]. 16 patients (male:female=3:1) occurred CIED infection, the incidence was 0.9%. Fifteen (93.8%) cases were identified as pacemaker pocket infection. Microorganisms were detected in 68.8% cases, Of which 90.9% was coagulase-negative staphylococci. Significant risk factors included implantation of ICD/CRT-D (P=0.000), diabetes mellitus (P=0.009) and thyroid hypofunction (P=0.000), odds ratio was 9.12, 4.18 and 37.55, respectively. The procedure of pacemaker replacement did not increase the risk of CIED infection (P>0.05). The body mass index (BMI) of male CIED infection patients, particularly of non-diabetic CIED infection men, was significantly lower than that of non-CIED infection men (P<0.05). Conclusion: The CIED infection rate is 0.9%, the vast majority showed pocket infection and coagulase-negative staphylococci are common pathogens. Implatation of ICD/CRT-D, diabetes mellitus and thyroid hypofunction are related risk factors of CIED infection; lower BMI men are more susceptible to CIED infection.

Key words： cardiovascular implantable electronic device infection coagulase negative staphylococcus body mass index

收稿日期: 2013-07-02

基金资助:温州市科技计划项目（2011S0234）。

通讯作者: 黄伟剑，主任医师，硕士生导师，Email：weijian huang69@126.com。

作者简介: 方丹红（1978-），女，浙江温岭人，主治医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2014/V44/I3/193

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