感染性心内膜炎的外科治疗

Surgical treatment of infective endocarditis

目的评价外科手术治疗感染性心内膜炎的经验和效果。方法回顾性分析15例感染性心内膜炎的外科治疗方法。先天性心脏病5例,风湿性心脏瓣膜病9例,右心室异物1例。术前超声检查赘生物形成14例,血培养阳性4例。全组病例中行心脏缺损矫正修补5例,主动脉瓣置换术5例,二尖瓣置换术4例。结果全组病例均无术中死亡,1例术后因严重低心排综合征早期死亡,14例治愈出院,随访6个月～4a,预后良好,无复发及死亡病例。结论手术治疗感染性心内膜炎是一种有效的治疗措施,它降低了感染性心内膜炎的病死率。正确掌握手术时机,彻底清除感染病灶,恢复瓣膜功能以及围手术期应用有效抗生素是提高感染性心内膜炎治愈率的关键。

Objective To review the effectiveness and the outcomes of surgical treatment on patients with infective endocarditis. Methods This is a ret rospective study which included 15 cases with infective endocarditis,including 5 congenital heart diseases,9 rheumatic heart diseases,and 1 case with broken guided wire in right ventricle. Echocardiographic findings showed vegetations in 14 cases before surgery. Blood culture was positive in 4 cases. All the subjects have received surgical treatment involving aortic valve replacement in 5 patients,mitral valve replacement in 4cases. Results The operations were done successfully in all patients. There was one death occurred due to low cardiac out put syndrome in early postoperative stage. The other 14 cases were cured and no recurrent endocarditis or death was observed during the follow up period of 6 month ～ 4 years. Conclusion This study indicated that surgery is an effective treatment for infective endocarditis,which can reduce the mortality. Optimal timing of surgery,radical debridement infected tissue,recovery of valve function and utilizing antibiotics in perioperative stage are the key points to improve the surgical treatment in infected endocarditis.