外科治疗感染性心内膜炎249例

Surgical treatment of 249 cases with infective endocarditis

目的总结感染性心内膜炎249例的诊断、手术时机和疗效。方法回顾分析1988年1月～2006年6月接受手术治疗的感染性心内膜炎249例,先天性心脏病89例(35.7%),风湿性心脏病134例(53.8%),无基础病变者26例(10.4%),所有病人经外科手术清除感染病灶,纠治瓣膜病变及心脏畸形,术前进行血培养和彩色超声心动图检查。结果外科手术治疗前,超声心动图发现心脏及大血管赘生物219例(87.9%),血培养阳性103例(41.4%)。手术后死亡9例(3.6%)。结论感染性心内膜炎早期诊断,适时手术和内、外科联合治疗是治疗成功的关键。

Objectives To summarize the diagnosis, operation time and curative effect of 249 cases with infective endocarditis. Methods 249 cases with infective endocarditis receiving operation between January 1998 and June 2006 were analyzed retrospectively. All patients were treated by operation, and color-Doppler echocardiography were carried out before operation. The principles of the operations were to remove the infection tissue, correct and cure the pathological changes of valve and cardiac anomalies. Results Among the 249 cases, 89 cases of them had congenital heart disease（35.7%）, 134 cases had rheumatic heart disease （53.8%）, and 26 cases had no structural pathological changes （10.4%）. Before surgical treatment, echocardiography found that 191 cases had vegetations on heart and great vessels （76.8%）, positive blood cultivations were found in 103 cases. After operation, 9 cases （3.6%）died. Conclusions The key to treat infective endocarditis successfully depends on early diagnosis, operation at the fight time, and combination of internal and surgical treatment.