北京安贞医院心内科任学军(编辑修改稿)

北京安贞医院心内科任学军(编辑修改稿)内容摘要：

k factor analyses  Retrospective analysis (PPM only)  Antibiotic prophylaxis had a protective effect (OR,。 95% CI, –。 P=).  Prospective analysis (PPM and ICD)  Lack of antibiotic prophylaxis was associated with an increased risk of infection (HR,。 95% CI, –。 P)  Seven prospective clinical trials included (PPM)  Antibiotic prophylaxis was negatively correlated with risk of infection (adjusted OR,。 95% CI, –。 P=)  Metaanalysis  Seven prospective clinical trials included (PPM)  Antibiotic prophylaxis had a protective effect (OR,。 95% CI, –。 P=)  Clinical trial  Doubleblind, randomized, placebocontrolled clinical trial (PPM and ICD)  Patient enrollment was stopped prematurely because of a significant difference in favor of the antibiotic arm (RR,。 95% CI, –。 P=). 起搏器术后感染的危险因素： 围手术期抗生素是否使用  血肿和患者抗凝药物的使用密切相关  血肿是起搏器感染的危险因素  REPLACE Registry (5 of 22 [%] vs 17 of 1,722 [%], P = )  2020年 AHA/HRS指南已将预防血肿作为预防 CIED的重要措施 起搏器感染的危险因素：血肿 (Hematoma)和抗凝药物 起搏器植入术后感染的预防  患者相关  植入器械相关  植入过程相关  患者基础疾病的控制  呼吸，肾功能，心功能  24小时内的发热控制  抗凝 药的使用 起搏器感染的预防 —— 患者相关  起搏器的 选择  避免皮肤张力过大  起搏器的寿命：更换会增加感染的概率  电极的选用  特别是 ICD电极：对于感染高危因素的患者，可考虑使用单线圈电极  感染性心内膜炎患者：使用心外膜电极 起搏器术后感染的预防 —— 植入装置相关  术前  抗生素的使用  消毒  术 中  避免 污染  起搏器的放置  预防血肿的行成  术 后  预防血肿的行成 起搏器术后感染的预防 —— 植入过程相关  AHA/HRS/ACC指南  Remendations for Antimicrobial Prophylaxis at the Time of CIED Placement Class I： Prophylaxis with an antibiotic that has in vitro activity against staphylococci should be administered. If cefazolin is selected for use, then it should be administered intravenously within 1 hour before incision。 if vanycin is given, then it should be administered intravenously within 2 hours before incision. (Level of Evidence: A)。