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Odleżyna i miejscowa infekcja loży stymulatora/kardiowertera – rozpoznanie i leczenie

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Odleżyna loży PM/ICD to powikłanie mogące dotyczyć od kilku do kilkunastu procent pacjentów poddanych implantacji układów stymulujących serce. W przypadku niewdrożenia właściwej terapii może się ono wiązać z rozwojem powikłań zagrażających życiu chorego. 

Odleżyna loży PM/ICD to częsty problem kliniczny. Patogeneza tego schorzenia może mieć dwojaki charakter. Odleżyna może powstać wskutek mechanicznego podrażnienia skóry przez urządzenie (odleżyna jałowa) bądź w wyniku procesu infekcyjnego (zakażenie loży PM/ICD). W zależności od przyczyny wystąpienia zmian chorobowych obserwowane są różne objawy. Dla obu przypadków przewidziane są również inne procesy terapeutyczne. 

Objawy odleżyny loży stymulatora/kardiowertera

W przypadku odleżyny jałowej, spowodowanej zbyt płytkim umieszczeniem układu stymulującego, objawy mogą obejmować ścieńczenie skóry nad korpusem urządzenia oraz utratę jej przesuwalności. Objawy nie powodują dolegliwości bólowych i mogą pozostać niedostrzeżone przez pacjenta. 

W przypadku wystąpienia infekcji loży PM/ICD obserwuje się objawy takie jak: obrzęk tkanek wokół układu, zaczerwienienie, chełbotanie, podwyższona miejscowo temperatura. Objawom tym mogą towarzyszyć dolegliwości bólowe. Wysięk z loży to wyraźny sygnał toczącego się procesu infekcyjnego. 

W przypadku rozszerzania się zakażenia wzdłuż elektrod objawom miejscowym mogą towarzyszyć symptomy ogólne takie jak podwyższona temperatura, dreszcze czy duszności

Czynniki ryzyka odleżyny loży PM/ICD

Wśród czynników ryzyka wystąpienia odleżyny loży PM/ICD wymienia się:

  • długo trwający zabieg implantacji układu i małe doświadczenie operatora;
  • zbyt płytkie ułożenie korpusu urządzenia; 
  • zbyt dużą liczbę wszczepionych elektrod; 
  • brak zachowania zasad aseptyki podczas zabiegu oraz brak profilaktyki antybiotykowej;
  • choroby współistniejące (zwłaszcza cukrzyca, niewydolność wątroby i nerek); 
  • immunosupresja; 
  • wielokrotną reimplantację lub repozycję układu.

Leczenie i możliwe powikłania

W przypadku zachowania ciągłości skóry nad korpusem układu i braku objawów infekcji leczenie może polegać na repozycji urządzenia w głębsze warstwy tkanek. Odleżyna loży z towarzyszącym procesem bakteryjnym jest w większości przypadków wskazaniem do usunięcia całego układu. Ponowna implantacja możliwa jest po opanowaniu infekcji. 

Zakażenie loży, w przypadku którego nie zostanie wdrożone właściwe leczenie, może rozszerzyć się wzdłuż elektrod, co w konsekwencji prowadzi do uogólnienia procesu infekcyjnego i bakteryjnego zapalenia wsierdzia

Źródło: 

M. Kempa, T. Królak i in., “Odleżyna w loży stymulatora/kardiowertera-defibrylatora serca. Problem zbyt często przeoczony”, Forum Medycyny Rodzinnej 2013, tom 7, nr 5, 277–281.

Przeczytaj także: Bakteria jak w sieci pająka: naukowcy odkryli nowe mechanizmy immunologiczne

Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Pielęgniarstwo w Anestezjologii i Intensywnej Opiece”:

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