原发性感染性心内膜炎的外科治疗(附102例报告)

Surgical Intervention of Primary Infective Endocarditis:A Report of 102 Cases

回顾性分析原发性感染性心内膜炎１０２例，其中主动脉瓣病变７１例，二尖瓣病变１６例，主动脉瓣与二尖瓣联合病变６例，三尖瓣病变５例，肺动脉瓣病变４例。按照病人术前心功能状态，分为：（１）急性心功能不全组（２５例）；（２）慢性心功能不全组（７７例）。施行主动脉瓣替换术７１例，二尖瓣替换术１６例，双瓣替换术６例，三尖瓣修复成形术５例，肺动脉瓣成形术４例。术后早期死亡９例（８．８％）。９３例生存者随访时间３个月～１６年，平均随访时间４．３年。晚期死亡６例，其中２例为人工瓣膜心内膜炎，复发率为２％。作者对手术时机与手术方式的选择作了讨论，并介绍了围术期处理的经验。

Objective and method:We reviewed 12 years' experience with surgical intervention of primary infective endocarditis in 102 patients.These patients were divided into two categories:group with acute cardiac dysfunction(n=25)and group with chronic cardiac dysfunction(n=77).In all patients,surgical intervention was performed including aortic valve replacement in 77,mitral valve replacememt in 16,combined aortic and mitral valve replacements in 6,tricuspid valve reconstruction in 5 and pulmonary valve repair in 4.Results:There were 9 early postoperative deaths giving an overall hospital mortality of 8.8%.Follow up of 3 months to 16 years,with a mean of 4.3 patient years,documented 6 late deaths affributed to recurrent prosthetic endocarditis (2.0%).Conclusion:appropriate timing of operation,experienced surgical technique and adequate periopearative management were the main determinates in affecting the prognosis of the patients with primary infective endocarditis.