凌峰起搏器感染的预防.ppt

术中预防植入性器械感染措施 囊袋制作时应注意合适的囊袋大小和合适的皮肤张力，起搏器放入囊袋后，其上缘应在肋缘下方0.5cm，脂肪层特别松弛者，应将起搏器固定于胸大肌上。囊袋张力过大会导致皮肤破溃或皮肤压迫性坏死，皮肤坏死60%由不明显感染引起，20%是放置脉冲发生器时技术性的缺点引起，其余20%为组织敏感所致，对疲弱、皮肤皮下脂肪薄患者需考虑将起搏器埋置在较深的肌肉筋膜间的必要性。 预防植入性器械感染措施 预防囊袋血肿（严密止血，穿刺口荷包缝合防止静脉血液外流、局部应用凝血酶、抗生素溶液冲洗囊袋、术后12到24小时囊袋压迫等） 预防植入性器械感染措施 术后即刻 应避免使用低分子肝素，因为可能易于血肿的形成 只有当血肿严重压迫到皮肤时才进行血肿切除，因为穿刺时针头可能将皮肤上的微生物带入囊袋引起感染 术后随访 病人如果发烧或者有切口炎症，因及时告知植入医生 术后早期门诊随访和病人教育对于早期发现感染都是很有必要的。 总结 * Although the causes of surgical site infections may not be precisely identified, there appears to be general agreement that the sources of infecting organisms in the O.R. include : the patient, surgical team, other attending personnel, environmental air, walls and floors, material and equipment. A study done by Christopher Drake which was published in 1977, concludes that the most common source of micro organisms causing surgical infections is the patient himself. The organisms implicated in such infections are among the endogenous flora harboured by the patient. The incidence of patient wound infections caused by common skin flora (Staph) is growing. Since 1980 stahpylococcus Aureus has been the most important frequent cause of surgical site infection . In the 90’s Coagulase-negative staphylococci (CNS) have become a major concern because of their role in foreign-body-related infections. (National Nosocomial Infection Study (NNIS), Centers for Disease Control(CDC). * Underneath the incise drape you do not want to have migration of microorg into the wound Also want to prevent regrowth Incise drapes creates a sterile surface Adhesion important as it takes care of the migration of microorg. If incise drapes lifts off the skin, microorg underneath the drape contaminate the wound edges. When that happens, the best thing to do is either remove the incise drape and disinfect the skin again, or use an incise drape which adheres very well (SD2 or ioban (adheres better than SD2)). Dead stretch means that the drape stretches b