感染性心内膜炎的外科治疗

Surgical treatment of infective endocarditis

目的:总结53例感染性心内膜炎的诊断、手术时机和治疗方法以及效果。方法:回顾性分析2003年1月～2007年5月接受感染性心内膜炎手术治疗患者53例的临床资料。以发热为主就诊者19例;术前心功能不全(NYHAⅢ级或Ⅳ级)22例;脑栓塞3例;肺栓塞并肺炎2例;血培养阳性者8例(15.1%),多为革蓝氏阳性菌;超声证实心内赘生物形成者51例。所有患者均在体外循环下,进行赘生物清除及原发心脏病矫正手术。术后继续使用抗生素治疗2～6周。结果:52例患者均痊愈出院。1例患者术后1个月复发,再手术后痊愈。所有病例随访3个月恢复良好。结论:感染性心内膜炎应做到早诊断、早治疗,对于无法控制的感染和难以纠正的心力衰竭以及反复发生体动脉栓塞患者要及时采用手术治疗,同时加强围手术期处理,可明显提高感染性心内膜炎的治愈率,降低死亡率。

Objective：To summarize the diagnosis, the optional timing, the therapeutic method and effect of 53 infective endocarditic （IE） cases. Method： Clinical data of 53 IE cases, treated surgically from January 2003 to may 2007 were retrospectively analyzed. All cases were complicated with primary cardiac diseases. Fever was the chief clinical feature in 19 patients and preoperative heart dysfunction （NYHA Ⅲ or Ⅳ） in 22 patients. Brain embolism was in 3 patients and pulmonary embolism in 2 patients. Blood culture was taken in all cases, and 8 of them were positive （15.1%）. Most pathogenic germs were Gram-positive. Vegetations were in 51 cases founded by echoeardiography. Vegetations were cleared and original heart diseases were corrected at the same time under cardio-pulmonary bypass for all patients. Antibiotic therapy was continued for 2-6 weeks. Result：52 patients reeoveryed and were discharged. IE recurred in 1 patient after 1 month of the operation and the patient recovered after reoperation. Following up for 3 months all patients recoveryed well. Conclusion：Infective endocarditie case should be diagnosis and treated early. Patients with persistent bacteremia or heart failure or with recurrent arterial embolism in extremities should be operated early. The strength of perioperative treatment can increase cure rate and decrease death rate.