Zhang Benqing,Wang Wenzhang,Li Shoujun.A comparative study of two treatment schemes for poor incision healing after battery replacement of permanent pacemaker in children[J].Journal of Clinical Pediatric Surgery,,19():331-335,346.[doi:10.3969/j.issn.1671-6353.2020.04.010]
A comparative study of two treatment schemes for poor incision healing after battery replacement of permanent pacemaker in children
- Keywords:
- Pacemaker; Artificial; Wound Healing; Clinical Protocols
- CLC:
- R726.9;R318.11
- Abstract:
- Objective To compare two different treatment methods for poor incision healing after battery replacement of permanent pacemaker in children.Methods The medical records were analyzed retrospectively for 11 children with poor incision healing after pacemaker battery replacement at Fuwai Hospital and Hebei Yanda Hospital from January 2001 to November 2019.There were 7 boys and 4 girls with an average age of (7.3±2.5) years.The average time of battery replacement was (4.1±1.5) years since the last pacemaker battery implantation.The secretions were purulent (n=7) and clear (n=4).Eight children were readmitted within 3 weeks post-surgery while another three were readmitted at 45,40 and 32 days post-surgery respectively.Fever was low (n=5) and none (n=6).For facilitating statistical analysis,they were divided into operation group (n=6) and routine dressing group (n=5).In operation group,1 patient underwent enlarged bag debridement and suture and another 5 original bag resection and suture.All 5 patients in routine dressing group received cephalosporin or vancomycin.Iodophor gauze was replaced twice daily and two of them received continuous negative pressure suction for 2 weeks.Results All 6 patients in operation group were cured and discharged within 2 weeks post-surgery with an average length of stay of (11±3) days.The drainage tube was removed within 3 days post-surgery with an average drainage volume of (25.6±10.1) ml.Postoperative follow-ups by telephone showed no further adverse incision healing.None of them had systemic infection or infective endocarditis.Incision healing was decent and efficacy satisfactory.In routine dressing change group,the average hospital stay was (30±5) days.One patient was re-admitted 2 months after discharge.The original abdominal pacemaker was removed and replaced by an endocardial pacemaker.Significant inter-group difference existed in hospital stay (t=-9.6,P<0.01).Also significant difference existed in C-reactive protein before discharge (t=-2.8,P<0.05).Conclusion For poor healing of incision after battery replacement of permanent pacemaker in children,satisfactory outcomes may be obtained by removing the original pacemaker bag,reducing foreign body implantation,intermittent suturing of absorbable string and properly liberating skin slice for lowering anastomotic tension.As compared with routine dressing change,this method can significantly reduce the time of hospitalization,relieve the pain of patients and reduce the incidence of reinfection.
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Memo
收稿日期:2019-12-29。
基金项目:国家重点研发计划项目资助（编号：2017YFC1308100）
通讯作者:李守军,Email:drlishoujun@163.com