感染性心内膜炎的外科治疗

Surgical treatment of infective endocarditis

目的 分析感染性心内膜炎的诊断、手术时机和疗效。方法 7例感染性心内膜炎均接受手术治疗。合并先天性心脏病1例 ,风湿性心脏病 4例。术前均经抗菌治疗 2周以上。血培养阳性 2例 ,均为链球菌。超声心动图发现赘生物 6例 ,脾脓肿 1例。手术中清除所有病灶 ,同期瓣膜置换 6例 ,心内畸形矫治 1例。结果 术后死亡 2例。术后并发症包括急性肾功能衰竭 1例、脑出血 1例及瓣周漏 1例 ,其他患者随访至今无心内膜炎复发 ,心功能改善。结论 感染性心内膜炎早期诊断 ,适时外科手术和内外科联合治疗是治疗成功的关键。

Objective To analyse the diagnosis, the optional timing and therapeutic effect of infective endocarditis (IE).Methods 7 cases of IE were treated by cardiac surgical operation. 1 case were complicated with congenital heart lesions, 4 cases suffered from rheumatic heart disease. Before operation, antibiotic treatment was give to 7 cases beyond two weeks. Blood culture was taken in 7 cases, 2 of whom were positive, caused by streptococcus. Echocardiography found vegetations in 6 cases, spleen abscess in 1 case. During operation all infected focals were cleared, valve replacement was carried out in 6 cases, intracardiac correct of malformation in 1 cases.Results postoperative death occurred in 2 cases. The main postoperative complications were acute renal failure in 1 case, cerebral hemorrhage in 1 case and periprosthetic leakage in 1 case, the other 5 cases were followed up, who had no recurrent IE but improved caradiac function.Conclusions Early diagnosis and aggressive medical therapy are necessary combined with well-timed surgical therapy.