术前加用75％酒精擦拭皮肤对心血管植入式电子装置手术感染发生率的影响

摘要

目的 比较心血管植入式电子装置术前加用75％的酒精擦拭皮肤和单纯用络合碘擦拭局部皮肤的感染发生率,探讨心血管植入式电子装置术前加用75％的酒精擦拭皮肤是否可减少感染的发生率.方法 根据是否在术前进行局部酒精擦拭将本院4 322例心血管植入式电子装置的患者分为:单纯组和联合组.单纯组:术中单纯用络合碘消毒局部皮肤1 067例(2003年07月至2008年12月),联合组:术前用75％的酒精擦拭后术中再用络合碘消毒皮肤3 255例(2009年01月至2015年07月).随访至少1年内所有患者是否发生器械植入相关的感染.比较两组局部皮肤处理方法的感染率、感染发生的时间及程度差异.结果 两组患者的基线资料(肾功能损害、抗凝血药物使用、临时起搏等)无明显差异,两组患者的心血管植入式电子装置类型无明显差异,单纯组中共有18例(1.69％)发生感染,而联合组中共有6例(o.18％o)发生感染.酒精擦拭组的早期感染发生率(0.03％ vs 0.28％)、中期感染发生率(0.09％ vs 0.47％)、延迟感发生率(0.03％ vs 0.28％)及远期感染的发生率(0.03％ vs 0.66％)均低于单纯组.感染组与未感染组在糖尿病、手术时间、是否酒精擦拭及CIED类型等方面有差异.结论 术中常规络合碘消毒皮肤前加用75％的酒精擦拭可明显降低心血管植入式电子装置相关的感染发生率.%Objective To evaluate whether additional preoperative skin wiping with 75％ alcohol could reduce the incidence of cardiovascular implantable electronic devices(CIED) infection.Methods Consecutive 4 322 cases of CIED implantation or replacement were divided into just povidone-iodine group (July 2003-December 2008) with just povidone-iodine scrub and paint (n =1 067) and alcohol wiping group (January 2009-July 2015) with additional skin wiping with 75 ％ isopropyl alcohol lasting for at least 5 minutes until removing dirt just before povidone-iodine scrub andpaint (n=3 255).Compare the incidence of pocket infection,septicemia,and device extraction due to infection at least one year after implantation/replacement.Result There was no significant difference in background data of CIED infection risk factors identified by past studies(renal insufficiency,anticoagulant use,temporary pa cing,generator replacement,and ICD implantation) between two groups.During the follow-up period,18 cases (1.69 ％) in just povidone-iodine group were confirmed CIED infection and 6 cases (0.18 ％)) in alcohol wiping group.All the early infection incidence (0.03％ vs 0.28％),medium term infection incidence (0.09％ vs 0.47％),delayed infection incidence (0.03 ％ vs 0.28 ％) and long-term infection rate (0.03 ％0 vs 0.66 ％) in alcohol wiping group were lower than just povidone-iodine group.There was a significant difference in body mass index,diabetes mellitus,operation time,alcohol wiping and CIED type between infected and uninfected groups.Conclusion Preoperative skin wiping with 75 ％ alcohol reduces infections in CIED surgery.