青少年及成人先天性心脏病感染性心内膜炎的临床研究

Infective Endocarditis in Grown-up Congenital Heart Disease(GUCH)Population

感染性心内膜炎占青少年及成人先天性心脏病科住院人数的４～５％。本文研究了１７７例（１３～７４岁，平均年龄２６岁：男：女为１．５：１）２０５次感染性心内膜炎，以确定受感染之先天性心脏缺损之种类，诊断的延误，死亡率及外科治疗对预后的影响。１４９次心内膜炎发生在根治性心脏手术之前（组１），其中２１例病人接受过减状治疗：５６次发生在手术根治后病人（组２）。最常见受累的缺损为主动脉瓣疾患（４３次），小室间隔缺损（４１次）和法乐氏四联症（２４次）。牙科检治，手术中及延长的围术期治疗以及皮肤创伤感染是最常见的诱发因素，有明确细菌学培养结果者１３９人次，其中最常见的为草绿色链球菌，在组１为５５％，组２为４９％；金黄色葡萄球菌感染组２（２５％）比组１（１３％）高。诊断延误时间在组１明显长于组２。在感染活动期特别是金黄色葡萄球菌感染时外科紧急手术治疗有时是必须的。手术根治后的先天性心脏病患者凡遗留有任何血流动力学改变者都需要预防感染性心内膜炎（包括换瓣病人）。

Endocarditis accounts for 4～5% of adimissions to a specialized GUCH unit.177 patients aged l3～74 years(mean 26)Male:Female=1.5:l with 205 attacks of infective endocarditis(I.E)were studied to define lesions affected,delay in diagnosis,mortality and influence of surgery.149 episodes of I.E occurred before definitive surgery(Group I),2l of whom had palliative surgery,and 56 occurred after corrective operation(Group Ⅱ).The most frequent lesions attacked were aortic valve(43),small VSD(4l)and TOF(24).Dental procedure(39),intra or prolonged peri-operative care(14)and skin trauma(8)are the commonest antecedent events.In l39 with bacteriology known,the commonest organisms were viridans streptococci in both Group I(55%)and Group II(49%)Staphylococcus aureus infection was higher in Group II(25%)than in Group I(13%).Delay in diagnosis was significantly longer in Group I.Surgery may be needed during active infection particularly with staphylococcus aureus.All patients with congenital heart disease need prevention of I.E after corrective surgery if there is and residual haemodynamic instability.