左心室辅助装置植入患者感染预防及管理的最佳证据总结

doi:10.3761/j.issn.2096-7446.2026.03.019

摘要/Abstract

摘要：

目的总结并评价左心室辅助装置（left ventricular assist device，LVAD）植入患者感染预防及管理的相关证据，为临床工作提供参考依据。方法依据PIPOST模式确立循证问题，系统检索中英文数据库关于LVAD植入患者感染预防相关的推荐实践、指南、专家共识及建议、系统评价、原始研究及证据总结，检索时限为建库至2025年2月1日。结果共纳入文献20篇，包括推荐实践3篇、指南2篇、专家共识10篇、证据总结3篇、系统评价2篇。最终总结出包括多学科团队协作及人员培训、感染的预防、感染后规范化管理及出院指导4个主题，共30条最佳证据。结论该研究详细总结了LVAD植入患者感染预防及管理的最佳证据，具备一定的科学性与实用性，可为医护人员LVAD植入患者感染预防及管理提供循证依据。

关键词: 心力衰竭, 左心室辅助装置, 感染预防, 证据总结, 循证护理学

Abstract:

Objective To summarize and evaluate the evidence related to infection prevention and management in patients implanted with left ventricular assist devices（LVADs），providing a reference for clinical practice.Methods Based on the PIPOST model，we formulated evidence-based questions and systematically searched both Chinese and English databases for recommendations，guidelines，expert consensuses，suggestions，systematic reviews，original studies，and evidence summaries related to infection prevention in LVAD patients. The search covered the period from the establishment of the databases to February 1，2025.Results A total of 20 articles were included，including 3 recommended practices，2 guidelines，10 expert consensus articles，3 evidence summaries，and 2 systematic reviews. A total of 30 best evidence items were ultimately summarized across four themes：multidisciplinary team collaboration and personnel training，prevention of infections，standardized management of infections，and discharge guidance.Conclusion This study provides a detailed summary of the best evidence for infection prevention and management in LVAD patients，which is both scientific and practical. It can serve as an evidence-based reference for healthcare professionals in preventing and managing infections in LVAD patients.

Key words: Heart Failure, Left Ventricular Assist Device, Infection Prevention, Evidence Summary, Evidence-Based Nursing

邓猛, 高鹤雷, 王文春, 李晓青, 张宗豪, 俞云. 左心室辅助装置植入患者感染预防及管理的最佳证据总结[J]. 中华急危重症护理杂志, 2026, 7(3): 358-365.

DENG Meng, GAO Helei, WANG Wenchun, LI Xiaoqing, ZHANG Zonghao, YU Yun. Best evidence summary for infection prevention and management in patients with left ventricular assist device implantation[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(3): 358-365.

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参考文献 34

[1]	Djordjevic JZ, Özkan T, Göncz E, et al. Common complications and cardiopulmonary resuscitation in patients with left ventri-cular assist devices:a narrative review[J]. Medicina, 2023, 59(11):1981.
[2]	Virani SS, Alonso A, Aparicio HJ, et al. Heart disease and stroke statistics-2021 update:a report from the American Heart Asso-ciation[J]. Circulation, 2021, 143(8):e254-e743.
[3]	Pavlovic NV, Randell T, Madeira T, et al. Risk of left ventri-cular assist device driveline infection:a systematic literature review[J]. Heart Lung, 2019, 48(2):90-104.
[4]	王雪皎, 朱懿珍, 谢霞, 等. 心力衰竭患者左心室辅助装置传动系统感染的研究进展[J]. 中国感染控制杂志, 2022, 21(4):404-408.
	Wang XJ, Zhu YZ, Xie X, et al. Research progress on left ven-tricular assist device driveline infection in patients with heart failure[J]. Chin J Infect Contr, 2022, 21(4):404-408.
[5]	Gopinathannair R, Cornwell WK, Dukes JW, et al. Device thera-py and arrhythmia management in left ventricular assist device recipients:a scientific statement from the American Heart Association[J]. Circulation, 2019, 139(20):e967-e989.
[6]	马艳, 吴荣, 张辰, 等. 左心室辅助装置植入患者术后护理专家共识[J]. 中华护理杂志, 2024, 59(14):1687-1690.
	Ma Y, Wu R, Zhang C, et al. Expert consensus on postopera-tive care of patients with a left ventricular assistant device[J]. Chin J Nurs, 2024, 59(14):1687-1690.
[7]	Koval CE, Stosor V, ID Community of Practice AST. Ventricular assist device-related infections and solid organ transplantation-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice[J]. Clin Transplant, 2019, 33(9):e13552.
[8]	Kusne S, Staley L, Arabia F. Prevention and infection manage-ment in mechanical circulatory support device recipients[J]. Clin Infect Dis, 2017, 64(2):222-228.
[9]	Ho G, Braun OÖ, Adler ED, et al. Management of arrhythmias and cardiac implantable electronic devices in patients with left ventricular assist devices[J]. JACC Clin Electrophysiol, 2018, 4(7):847-859.
[10]	黄翱黎, 朱旭菁, 杨巧珍, 等. 左心室辅助装置植入患者术后并发症预防及管理的最佳证据总结[J]. 中华急危重症护理杂志, 2024, 5(9):849-855.
	Huang AL, Zhu XJ, Yang QZ, et al. Summary of the best evidence for postoperative complication prevention and mana-gement of patients with left ventricular assist device implan-tation[J]. Chin J Emerg Crit Care Nurs, 2024, 5(9):849-855.
[11]	肖兴米, 彭林敏, 涂惠, 等. 植入左心室辅助装置患者经皮缆线伤口护理的证据总结[J]. 中国护理管理, 2024, 24(12):1886-1891.
	Xiao XM, Peng LM, Tu H, et al. Evidence summary for percutaneous cable wound care in patients with implanted left ventricular assist device[J]. Chin Nurs Manag, 2024, 24(12):1886-1891.
[12]	郭红艳, 李晶, 王玉英, 等. 植入心室辅助装置患者经皮线缆伤口感染预防与处理最佳证据总结[J]. 中华现代护理杂志, 2021, 27(35):4781-4787.
	Guo HY, Li J, Wang YY, et al. Summary of the best evidence for the prevention and management of wound infections in patients with ventricular assist devices[J]. Chin J Modern Nurs, 2021, 27(35):4781-4787.
[13]	Brouwers MC, Kerkvliet K, Spithoff K, et al. The AGREE Re-porting Checklist:a tool to improve reporting of clinical practice guidelines[J]. BMJ, 2016,352:i1152.
[14]	AROMATARIS EMZ. Joanna Briggs Institute reviewer’s manual[EB/OL](2017-07-15)[2022-02-07]. https://wiki.joan-nabriggs.org/display/MANUAL/Joanna+Briggs+Institute+Revie-wer%27s+Manual.
[15]	Foster MJ, Shurtz S. Making the critical appraisal for sum-maries of evidence(CASE) for evidence-based medicine (EBM):critical appraisal of summaries of evidence[J]. J Med Libr Assoc, 2013, 101(3):192-198.
[16]	Hayward C, Adachi I, Baudart S, et al. Global best practices consensus:Long-term management of patients with hybrid centrifugal flow left ventricular assist device support[J]. J Tho-rac Cardiovasc Surg, 2022, 164(4):1120-1137.e2.
[17]	Bernhardt AM, Schlöglhofer T, Lauenroth V, et al. Prevention and early treatment of driveline infections in ventricular assist device patients-The DESTINE staging proposal and the first standard of care protocol[J]. J Crit Care, 2020,56:106-112.
[18]	杜娟, 邹亮, 陈伊, 等. 中国左心室辅助装置植入术后早期重症监护管理专家共识(2024年)[J]. 中国循环杂志, 2024, 39(8):729-750.
	Du J, Zou Li, Chen Y, et al. Expert consensus on early pos-toperative intensive care management after left ventricular assist device implantation(2024)[J]. Chin Circ J, 2024, 39(8):729-750.
[19]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[20]	Garrigos. Left ventricular assist device infection[EB/OL].(2024-10-08)[2025-07-31]. https://www.uptodate.com/contents/zh-Hans/left-ventricular-assist-device-lvad-infections?search.
[21]	Birks. Long-term mechanical circulatory support devices are used to treat advanced heart failure[EB/OL](2024-09-30)[2025-01-31]. https://www.uptodate.com/contents/zh-Hans/treat-ment-of-advanced-heart-failure-with-a-durable-mechanical-circu-latory-support-device?search.
[22]	Donna. Management of long-term mechanical cycle support de-vices[EB/OL].(2022-07-22)[2025-01-31]. https://www.uptoda-te.com/contents/zh-Hans/management-of-long-term-mechanical-cir-culatory-support-devices?search.
[23]	Ono M, Yamaguchi O, Ohtani T, et al. JCS/JSCVS/JATS/JSVS 2021 guideline on implantable left ventricular assist device for patients with advanced heart failure[J]. Circ J, 2022, 86(6):1024-1058.
[24]	Luong ML, Nakamachi Y, Silveira FP, et al. Management of in-fectious disease syndromes in thoracic organ transplants and mechanical circulatory device recipients:a Delphi panel[J]. Transpl Infect Dis, 2024, 26(3):e14251.
[25]	Trachtenberg B, Cowger J, Jennings DL, et al. HFSA expert consensus statement on the medical management of patients on durable mechanical circulatory support[J]. J Card Fail, 2023, 29(4):479-502.
[26]	Jezovnik. Medical complications in patients with LVAD devi-ces[EB/OL].(2022-07-22)[2025-01-31]. https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-14/Medical-complications-in-patients-with-LVAD-devices.
[27]	王艺萍, 王文艳, 左明良, 等. 左心室辅助装置植入全程管理专家共识(2023年)[J]. 实用医院临床杂志, 2024, 21(1):43-55.
	Wang YP, Wang WY, Zuo ML, et al. Expert consensus on the whole-process management of left ventricular assist device implantation 2023[J]. Pract J Clin Med, 2024, 21(1):43-55.
[28]	Krzelj K, Petricevic M, Gasparovic H, et al. Ventricular assist device driveline infections:a systematic review[J]. Thorac Car-diovasc Surg, 2022, 70(6):493-504.
[29]	Koken ZO, Yalcin YC, van Netten D, et al. Driveline exit-site care protocols in patients with left ventricular assist devices:a systematic review[J]. Eur J Cardiothorac Surg, 2021, 60(3):506-515.
[30]	王娟, 董瑞莹, 张静漪, 等. 左心室辅助装置植入患者出院计划的最佳证据总结[J]. 护理学杂志, 2024, 39(22):57-62,71.
	Wang J, Dong RY, Zhang JY, et al. Best evidence summary of discharge planning among patients with left ventricular assist device implantation[J]. J Nurs Sci, 2024, 39(22):57-62,71.
[31]	Jorde UP, Saeed O, Koehl D, et al. The society of thoracic surgeons intermacs 2023 annual report:focus on magnetically levitated devices[J]. Ann Thorac Surg, 2024, 117(1):33-44.
[32]	Saeed D, Feldman D, El Banayosy A, et al. The 2023 inter-national society for heart and lung transplantation guidelines for mechanical circulatory support:a 10-year update[J]. J Heart Lung Transplant,2023, 42(7):e1-e222.
[33]	Yarboro LT, Bergin JD, Kennedy JLW, et al. Technique for minimizing and treating driveline infections[J]. Ann Cardiotho-rac Surg, 2014, 3(6):557-562.
[34]	Husain S, Sole A, Alexander BD, et al. The 2015 International Society for Heart and Lung Transplantation Guidelines for the management of fungal infections in mechanical circulatory support and cardiothoracic organ transplant recipients:Execu-tive summary[J]. J Heart Lung Transplant, 2016, 35(3):261-282.