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目的探讨起搏器植入术后并发局部慢性溃疡伴感染的综合治疗方法。方法 2005年1月2010年5月,收治4例心脏起搏器植入术后并发局部慢性溃疡伴感染的患者。男3例,女1例;年龄3～79岁。心脏起搏器植入术后囊袋感染致皮肤破溃伴慢性溃疡2例,起搏器植入后局部张力过高所致局部慢性溃疡2例,其中2例患有2型糖尿病。所有患者均经过长期严格换药保守治疗3个月以上。手术彻底切除感染创面及相关包囊并尽可能剪除部分导丝,甚至更换导丝,根据情况原位或异位植入起搏器,并放置橡皮引流条,应用敏感抗生素5～7d防治感染。术后2周拆线,主要观察患者切口对合情况,是否存在红肿、硬结、血肿、积液或化脓情况。结果 4例患者术后均Ⅰ期愈合;4例均获随访,随访时间7～11个月,平均9个月。原创面愈合好,无感染及溃疡发生。结论通过外科手术综合治疗难治性心脏起搏器植入术后并发症,能取得满意疗效。
Objective To investigate the comprehensive treatment of local chronic ulcer with infection after implantation of pacemaker. Methods From January 2005 to May 2010, 4 patients with local chronic ulcer complicated with infection after implantation of cardiac pacemaker were enrolled. 3 males and 1 females; aged 3 to 79 years. 2 cases of skin ulcer with chronic ulcer caused by capsular bag infection after implantation of pacemaker and 2 cases of local chronic ulcer caused by local tension after implantation of pacemaker, of which 2 cases had type 2 diabetes mellitus. All patients were conservative treatment of long-term strict replacement of more than 3 months. Surgical removal of infected wounds and related cysts and as far as possible cut off part of the guide wire, or even replace the guide wire, implanting pacemaker in situ or ectopic depending on the situation, and placed rubber drainage strips, the application of sensitive antibiotics 5 ~ 7d control infection. 2 weeks after suture removal, the main observation incision patients with the situation, whether there is swelling, induration, hematoma, effusion or purulent situation. Results All the 4 patients were healed by first intention. All the 4 patients were followed up for 7-11 months with an average of 9 months. The original surface healed well, no infection and ulcer occurred. Conclusion Through the comprehensive surgical treatment of refractory cardiac pacemaker implanted complications, can achieve satisfactory results.