感染性心内膜炎的诊断和外科治疗93例

Diagnosis and surgical treatment of infective endocarditis:report of 93 cases

目的:回顾性分析感染性心内膜炎的诊断和治疗效果并讨论其临床意义.方法:1998-1/2008-3我院行外科手术治疗感染性心内膜炎患者93例,男69例,女24例,年龄8～63(38.8±12.5)岁,其中先天性心脏病30例(32.2%),瓣膜病变58例(62.3%),无基础病变5例(5.5%).所有患者均经外科手术清除感染病灶及赘生物,并纠治瓣膜病变和心脏畸形.其中择期手术80例(86%),急诊13例(14.0%).术前术后应用大剂量敏感抗生素.结果:术后早期死亡5例(5.4%),术后随访时间3～72mo,随访78例(87.6%),均无心内膜炎复发,心功能恢复Ⅰ级61例,Ⅱ级17例.结论:早期诊断感染性心内膜炎,适当的手术时机、完善的手术矫治和内外科的联合治疗是治疗成功的关键.

AIM： To summarize the diagnostic and therapeutic effect of infective endocarditis （IE） retrospectively. METHODS： From January, 1998, to March,2008, 93 IE patients （69 males, 24 females） , aging from 8 to 63 years, underwent heart operation in our hospital. Among them,30 patients （32.2%） suffered from congenital heart disease,58 （62.3%） suffered from the patholog- ical changes of valves, and 5 （5.5%） had no basic diseases. For all patients, infective tissues and vegetations were debfided radically, intracardiac malformation was corrected, and valve replacement or plasty was performed. There were 80 selective surgeries and 13 emergent ones. High dose of sensitive antibiotics were used all through the treatment in all IE patients. RESULTS： The early-death occurred in 5 cases （ 5.4% ）. Follow-up visit lasted for 3 - 72 mo in 78 patients （ 87.6% ） with no-recurrence. Postoperative cardiac function （NYHA） evaluation displayed Class I in 61 cases, and Class Ⅱ in 17 cases. CONCLUSION： The successful treatment of IE depends on early diagnosis, optimal surgical timing, complete surgical correction, and combination of internal medicine and surgical treatment.