感染性心内膜炎的诊断和外科治疗

Diagnosis and surgical treatment of infective endocarditis

目的:总结134例感染性心内膜炎的病理特点和外科治疗经验,以期更好地掌握手术时机和指征,提高对该病的诊治水平.方法:回顾性分析2002-07/2008-09我院感染性心内膜炎手术患者134(男91,女43)例,年龄9mo～68岁,病史16d～27mo.继发于先天性心脏病102例,风湿性瓣膜病29例,无基础心脏病3例.临床主要表现包括发热、气急、寒战、贫血、水肿、皮肤瘀斑和动脉栓塞.超声心动图检查提示128例患者有心内膜赘生物形成,血培养阳性29例(29/112).全组均在体外循环下通过外科手术清除感染病灶及赘生物,并同期处理瓣膜病变和修复心内畸形.术后继续应用抗生素6～8wk.结果:手术死亡1例,早期死亡8例.125例痊愈出院.随访92例,随访时间2～96(68.6±19.1)mo,感染均未见复发.心功能恢复至Ⅰ级73例,Ⅱ级19例.结论:感染性心内膜炎应做到早期诊断,适时而妥善的外科手术和内科联合治疗可获良好效果.

AIM： To sum up experience in the diagnosis and treatment of infective endocarditis （IE）and to improve the results of surgical repairs. METHODS： The clinical data of 134 IE patients treated by heart operations in our hospital from July, 2002 to September, 2008 were reviewed retrospectively. The patients were 91 males and 43 females with ages ranging from 9 months to 68 years and the duration of diseases from 16 d to 27 months. IE was secondary to congenital heart disease in 102 cases, to rheumatic heart disease in 29 cases and no structural pathological changes in 3 cases. Vegetations were found in 128 cases by ecbocardiography. The principal symptoms included fever, short breath, chills, anemia, edema, petechiae and arteri- al embolism. Infective tissues and vegetations were cleared and at the same time original heart diseases were corrected under the cardiopulmonary bypass in all the patients. Antibiotic therapy continued postoperatively for 6-8 weeks. RESULTS： One patient died of surgery and 8 died at the early stage. One hundred and twentyfive patients were recovered and discharged. Follow-up was performed in 92 patients and the duration was from 2 to 96 （68.6 ± 19.1 ） months. Recurrence of IE was found in no patients and the cardiac function status was NYHA Ⅰ in 73 cases and NYHA Ⅱin 19 cases. CONCLUSION： For infective endocarditis, early diagnosis, complete surgical correction and combination of internal medicine and surgical treatment will gain satisfactory results.