感染性心内膜炎的外科治疗

Surgical Management of Infective Endocarditis

目的：探讨感染性心内膜炎（ＩＥ）的诊断及外科治疗。方法：我院从１９８６年１１月至１９９６年５月，外科治疗感染心内膜炎患者１６例，其中男性１２例，女性４例。手术方法：全麻低温体外循环急诊换瓣手术７例（主动脉瓣替换５例，主动脉瓣＋二尖瓣替换１例，主动脉瓣替换＋膜部心室间隔缺损涤沦补片修补１例）；择期换瓣手术９例（主动脉瓣替换７例，二尖瓣替换２例）。切除瓣周感染组织，对散在于心室间隔和腱索上难以切除的微小赘生物电灼，术毕抗生素溶液冲洗心腔。结果：全组１６例。急诊手术７例，其中术后死亡１例（死亡率１４．３％），死亡原因为多器官衰竭；择期手术９例，无手术死亡。结论：反复多次血培养结合超声心动图检查，可使ＩＥ诊断阳性率大大提高。尽早手术是对部分ＩＥ患者治疗的基本原则，无法控制的感染和心力衰竭是尽早手术治疗的最佳适应证。

? Objective:To study the diagnosis and operation of the infective endocarditis(IE). Methods:From January 1986 to May 1996,16 patients (12 males and 4 females)with IE underwent operation.Seven of them underwent emergency operation,aortic valve replacement (AVR) in 5 cases,AVR+mitral valve replacement (MVR) in 1 and AVR +repair of membranous ventvicular septal defect in 1.Nine of them underwent operation (AVR in 7 cases and MVR in 2) after the infection and heart failure were controlled. Results:One of seven patients undergone emergency operation died of the multiple organ failure with the mortality of 143%.There were no death in nonemengency operation patients.Recurrence of infection was not found in all survival patients during followup. Conclusion:The surgical management of the IE should be performed as early as possible,especially when the infection or progressive heart failure can not be controlled.