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Circulation：置入ICD感染的发生率和预测因素

2014-08-04 宇思 编译 中国医学论坛报

ICD感染预测因素
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置入式心律转复除颤器(ICD)相关感染一直是困扰临床医生的棘手问题，7月31日在线发表于循环(Circulation)杂志的一项研究对ICD感染的发生率和预测因素进行了探讨。 该大型队列研究纳入200909例ICD置入术后患者，其中3390例患者(1.7%)发生ICD感染。单腔、双腔和双室ICD感染率分别为1.4%、1.5%和2.0%(P<0.001)。 回归分析结果显示，感染相关因素主

置入式心律转复除颤器(ICD)相关感染一直是困扰临床医生的棘手问题，7月31日在线发表于循环(Circulation)杂志的一项研究对ICD感染的发生率和预测因素进行了探讨。

该大型队列研究纳入200909例ICD置入术后患者，其中3390例患者(1.7%)发生ICD感染。单腔、双腔和双室ICD感染率分别为1.4%、1.5%和2.0%(P<0.001)。

回归分析结果显示，感染相关因素主要为置入除颤器后需再次介入时发生的不良事件，心脏瓣膜手术，由装置升级、故障或制造商建议等所致再置入，肾功能衰竭接受透析治疗，慢性肺病，脑血管疾病及应用华法林抗凝等。

在谈及起搏器感染时，天津医科大学总医院万征教授称之为“医生的噩梦”。万教授曾在报告中介绍了我国心血管置入装置(CIED)感染的现状。我国CIED置入量正迅速增加，1997-2005年起搏器并发症(包括感染、电极移位和导线折断)发生率为1.4%~1.9%，年置入量超过50台的医院发生起搏器并发症的比率低，起搏器感染发生率约为0.9%，虽报告感染率低于国外，但与实际发生率有差异。我国CIED感染可能有增加趋势，主要原因可能包括：在我国开展规范化培训较晚，参与操作的医生经验差异大，缺乏对CIED患者的规范管理，对相关感染缺乏认识及防范，高龄、有合并症的患者比例增加等。

处理CIED感染，重在预防!

原始出处：


Prutkin JM1, Reynolds MR2, Bao H3, Curtis JP3, Al-Khatib SM4, Aggarwal S5, Uslan DZ6.Rates of and Factors Associated with Infection in 200,909 Medicare Implantable Cardioverter-Defibrillator Implants: Results from the NCDR®Circulation. 2014 Jul 31. pii: CIRCULATIONAHA.114.009081. [Epub ahead of print]

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1860458, encodeId=119b1860458e3, content=<a href='/topic/show?id=d064933e0b' target=_blank style='color:#2F92EE;'>#ICD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9337, encryptionId=d064933e0b, topicName=ICD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87f580, createdName=yilong5287542, createdTime=Sat Sep 20 20:00:00 CST 2014, time=2014-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1826264, encodeId=d41d182626424, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Sat Aug 09 08:00:00 CST 2014, time=2014-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264212, encodeId=b273126421298, content=<a href='/topic/show?id=daf1100226fb' target=_blank style='color:#2F92EE;'>#预测因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100226, encryptionId=daf1100226fb, topicName=预测因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a57b78, createdName=朱睿睿, createdTime=Wed Aug 06 05:00:00 CST 2014, time=2014-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=10864, encodeId=69a91086409, content=在临床上也会遇到，ICD感染应该怎么处理呢？, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=69bd13185, createdName=hygeia1019, createdTime=Tue Aug 05 11:29:00 CST 2014, time=2014-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=10857, encodeId=a0b11085e80, content=很受用，不错。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=123.138.54.50, createdTime=Mon Aug 04 15:29:00 CST 2014, time=2014-08-04, status=1, ipAttribution=)]
    2014-09-20 yilong5287542

    #ICD#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1860458, encodeId=119b1860458e3, content=<a href='/topic/show?id=d064933e0b' target=_blank style='color:#2F92EE;'>#ICD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9337, encryptionId=d064933e0b, topicName=ICD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87f580, createdName=yilong5287542, createdTime=Sat Sep 20 20:00:00 CST 2014, time=2014-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1826264, encodeId=d41d182626424, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Sat Aug 09 08:00:00 CST 2014, time=2014-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264212, encodeId=b273126421298, content=<a href='/topic/show?id=daf1100226fb' target=_blank style='color:#2F92EE;'>#预测因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100226, encryptionId=daf1100226fb, topicName=预测因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a57b78, createdName=朱睿睿, createdTime=Wed Aug 06 05:00:00 CST 2014, time=2014-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=10864, encodeId=69a91086409, content=在临床上也会遇到，ICD感染应该怎么处理呢？, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=69bd13185, createdName=hygeia1019, createdTime=Tue Aug 05 11:29:00 CST 2014, time=2014-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=10857, encodeId=a0b11085e80, content=很受用，不错。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=123.138.54.50, createdTime=Mon Aug 04 15:29:00 CST 2014, time=2014-08-04, status=1, ipAttribution=)]
    2014-08-09 一叶知秋

    #发生率#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1860458, encodeId=119b1860458e3, content=<a href='/topic/show?id=d064933e0b' target=_blank style='color:#2F92EE;'>#ICD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9337, encryptionId=d064933e0b, topicName=ICD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87f580, createdName=yilong5287542, createdTime=Sat Sep 20 20:00:00 CST 2014, time=2014-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1826264, encodeId=d41d182626424, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Sat Aug 09 08:00:00 CST 2014, time=2014-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264212, encodeId=b273126421298, content=<a href='/topic/show?id=daf1100226fb' target=_blank style='color:#2F92EE;'>#预测因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100226, encryptionId=daf1100226fb, topicName=预测因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a57b78, createdName=朱睿睿, createdTime=Wed Aug 06 05:00:00 CST 2014, time=2014-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=10864, encodeId=69a91086409, content=在临床上也会遇到，ICD感染应该怎么处理呢？, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=69bd13185, createdName=hygeia1019, createdTime=Tue Aug 05 11:29:00 CST 2014, time=2014-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=10857, encodeId=a0b11085e80, content=很受用，不错。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=123.138.54.50, createdTime=Mon Aug 04 15:29:00 CST 2014, time=2014-08-04, status=1, ipAttribution=)]
    2014-08-06 朱睿睿

    #预测因素#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1860458, encodeId=119b1860458e3, content=<a href='/topic/show?id=d064933e0b' target=_blank style='color:#2F92EE;'>#ICD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9337, encryptionId=d064933e0b, topicName=ICD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87f580, createdName=yilong5287542, createdTime=Sat Sep 20 20:00:00 CST 2014, time=2014-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1826264, encodeId=d41d182626424, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Sat Aug 09 08:00:00 CST 2014, time=2014-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264212, encodeId=b273126421298, content=<a href='/topic/show?id=daf1100226fb' target=_blank style='color:#2F92EE;'>#预测因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100226, encryptionId=daf1100226fb, topicName=预测因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a57b78, createdName=朱睿睿, createdTime=Wed Aug 06 05:00:00 CST 2014, time=2014-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=10864, encodeId=69a91086409, content=在临床上也会遇到，ICD感染应该怎么处理呢？, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=69bd13185, createdName=hygeia1019, createdTime=Tue Aug 05 11:29:00 CST 2014, time=2014-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=10857, encodeId=a0b11085e80, content=很受用，不错。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=123.138.54.50, createdTime=Mon Aug 04 15:29:00 CST 2014, time=2014-08-04, status=1, ipAttribution=)]
    2014-08-05 hygeia1019

    在临床上也会遇到，ICD感染应该怎么处理呢？

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1860458, encodeId=119b1860458e3, content=<a href='/topic/show?id=d064933e0b' target=_blank style='color:#2F92EE;'>#ICD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9337, encryptionId=d064933e0b, topicName=ICD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87f580, createdName=yilong5287542, createdTime=Sat Sep 20 20:00:00 CST 2014, time=2014-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1826264, encodeId=d41d182626424, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Sat Aug 09 08:00:00 CST 2014, time=2014-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264212, encodeId=b273126421298, content=<a href='/topic/show?id=daf1100226fb' target=_blank style='color:#2F92EE;'>#预测因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100226, encryptionId=daf1100226fb, topicName=预测因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a57b78, createdName=朱睿睿, createdTime=Wed Aug 06 05:00:00 CST 2014, time=2014-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=10864, encodeId=69a91086409, content=在临床上也会遇到，ICD感染应该怎么处理呢？, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=69bd13185, createdName=hygeia1019, createdTime=Tue Aug 05 11:29:00 CST 2014, time=2014-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=10857, encodeId=a0b11085e80, content=很受用，不错。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=123.138.54.50, createdTime=Mon Aug 04 15:29:00 CST 2014, time=2014-08-04, status=1, ipAttribution=)]
    2014-08-04 123.138.54.50

    很受用，不错。。。

    0