| ObjectiveBy reviewing 1659 cases of patients,who is implanted CIED in our hospital Cardiology, of situation in 2008.1-2014.1, it is to explore,currently,the effectiveness of various methods to prevent the infection of CIED and the impacting infection of possible risk factors, to provides valuable experience which is worthy of learning for preventing the infection of CIED.MethodAdopt the method of retrospective analysis, collected in 2008.1-2014.1,1659 cases of patients,who is implanted CIED in our hospital Cardiology. Access to information in medical record room, making questionnaire establishes the database. (the appendix 1).Its content including name, age, sex,nation,the main diagnostic,level of cardiac function,malignant tumor, diabetes mellitus, preoperative 24 hours whether if fever, whether if long-term use of immunosuppression, whether oral anticoagulants, creatinine, urea nitrogen, blood coagulation function, the types of implanted CIED, whether infection, the operation time, operation duration, whether the pacemaker pocket of flushing,with what antibiotics flushing,whether using temporary pacemakers, hematoma, preoperative and after operation antibiotic the use of time (days) and so on,establishing a database. ① It is to explore effectiveness of each group for four groups,which are antibiotics before surgery, before surgery plus postoperative with antibiotics, postoperative use of antibiotics, unused antibiotics.②Effectiveness of flushing pacemaker pocket group and not flushing pacemaker pocket group.③ For these patients, according to CIED whether infection divided into infected and uninfected group.After finishing the survey date from valid data to describe the SPSS 17.0 software,it is to analyze which it is to affect the possible risk factors of infection. Using X2 test analysis for count data.Results1. The infection rate of CIEDInfection in 1659 patients with CIED in 31 cases, uninfected with 1628 cases, infection rate was 1.8%.2. The general situation2.1 The result of patients’ gender, age:①The patient of CIED 931 cases of male, female 728 cases, including 27 male infections, infection rate of 2.9%, the number of women infected with 4, infection rate 0.5%;②Age section:5-60 years group 523 cases,61-75 age group 753 cases,76-96 age group 383 cases;All ages infections, infection rate of,respectively,9 people,1.7%, 16 people,2.1%,9 people,1.6%.2.2 The cause of constituentsThe cause of constituents of patients who is implanted CIED:First for sick sinus syndrome (SSS),692 cases (41.7%), the second for arrhythmia,560 cases (33.8%), the third for dilated cardiomyopathy (DCM),128 cases (7.7%), three main cause infections people of 14 people,9 people,8 people respectively, infection rates were 2.0%,1.6% and 6.3% respectively.3、The groups of effectiveness of preoperative antibiotics、the preoperative and postoperative use of antibiotics、postoperative antibiotic、not to use antibiotic①Preoperative antibiotics of 174 people, four people of infection, infection rate 2.3%;Preoperative+postoperative use of antibiotics,309 people,0 people infection, infection rate 0%;Postoperative antibiotics of 631 people,8 people of infection, infection rate 1.3%;Not with antibiotics of 545 people,19 people of infection, infection rate of 3.5%. Not use of antibiotics and preoperative antibiotics group (χ2 =0.6, P>0.25), not use of antibiotics and before surgery plus postoperative antibiotics group (χ2= 11.0, P<0.01), without using antibiotics and postoperative antibiotics group (χ2=6.4, P<0.03).②Preoperative 30min with antibiotics of 157 people,2 people infection, infection rate 1.3%;Preoperative 30min+postoperative 1 time with antibiotics 42 people,0 infection, infection rate 0;use antibiotics in 6-8 days after surgery,210 people, zero infection, infection rate 0%;Not with antibiotics of 545 people,19 people infection, infection rate of 3.5%. Unused antibiotic group and before 30min surgery use antibiotics (χ2=1.4, P>0.10), without using antibiotics group and 30 min before surgery plus postoperative 1 time with antibiotics group (χ2=0.6, P>0.25), unused antibiotic group and the use of antibiotics with 6-8 days postoperative with antibiotics groups(χ2=7.5, P<0.01).4、The usage of antibiotics of pacemaker pocketFlushing pacemaker pocket,1133 cases,15 people of infection, infection rate 1.3%;not flushing pacemaker pocket,439 cases,16 people of infection, infection rate 3.6%. Unused antibiotic flushing pacemaker pocket group and with antibiotics flushing pacemaker pocket group (χ2=8.8, P<0.01).5、Affecting the possible risk factors of infection5.1、Patients with increased risk of infection drugs of situation:①Immunosuppressant use,17 cases, no people of infection, infection rate 0;1609 cases of unused immunosuppressant,infection of 31 people, infection rate of 1.9%.②Oral anticoagulants,476 cases,7 people of infection, infection rate 1.5%;Unused 1149 cases of oral anticoagulants, infection of 24 people, infection rate of 2.1%.5.2、Patients with other diseases:①Malignant tumor group,13 people,1 people of infections infection rate 7.7%;Without malignant tumor group,1616 people, the infection of 30 people, infection rate of 1.9%.②Diabetes group,188 people,1 people of infection, infection rate 0.5%;Group of 1441 people without diabetes, infection of 30 people, infection rate of 2.1%.③Creatinine normal group,1413 people,2 people of infection, infection rate 0.1%;Creatinine increased group,168 people, infection of 29 people, infection rate of 1.7%.④Urea nitrogen normal group,1398 people,2 people of infection, infection rate 0.1%;Urea nitrogen increased group,181 people,the number of infected 29 people, infection rate of 1.6%.⑤Coagulation function normal group, number 800 people, infection of 10 people, infection rate 1.3%;Higher coagulation function group, number 632 people,17 people of infection, the infection rate of 2.7%.5.3、Patients with level of cardiac function:Cardiac function in patients with grade 2 group, of 1047 cases, infection number 14, infection rate 1.3%, cardiac function level 3 groups with 582 cases,17 people infected, infection rate of 2.9%.5.4、Preoperative application of temporary pacemaker and operating time:①Temporary pacemaker used for 302 cases, infection of 4 people, infection rate 1.3%;not use temporary pacemaker for 1326 cases, infection number 27 people, infection rate 2.0%;②180min or less operation time for 1349 cases, infection number 31 people, the infection rate of 2.3%, operation time>180 min group,39 cases, the number of infected 0, infection rate of 0.6、Integrated by single factor analysis results as follows:① gender (χ2=12.92, P<0.01),② level of cardiac function (χ2=5.03, P= 0.03),③creatinine (χ2=220.12, P<0.01),④ urea nitrogen(χ2=201.97, P<0.01), and other factors to have statistical significance.Conclusion1、Level of first-class hospitals in Yunnan province the infection rates of CIED is similar to other regions in China.2、In Yunnan patients with the infection of CIED are men higher than women, age has no statistically significant in CIED of infection of risk factors.3、Yunnan in patients with the infection of CIED are the main causes of SSS,DCM,Arrhythmia (VT、AVB et al) in recent six years.The cause of the highest infection rate was DCM.4、Preoperative use of antibiotics group,preoperative and postoperative use antibiotics group, postoperative use antibiotics group, unused antibiotics group by the single factor analysis:①preoperative use of antibiotics is not protective factor;(2)the preoperative+postoperative use of antibiotics, postoperative use of antibiotics are protective factors.5、Whether or not Flushing pacemaker pocket by the single factor analysis results: used antibiotics flushing pacemaker pocket is the protective factors of infection.6、Single factor analysis and the conclusion:① male,② decreased cardiac function, ③ higher creatinine,④ higher urea nitrogen,and other factors to increase the risk of infection for implanting CIED. |
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