感染性心内膜炎的治疗

Surgical Treatment for Infective Endocarditis

回顾分析１９９１～１９９５年间２３例感染性心内膜炎（ＩＥ）治疗经验。本组均使用过多种抗生素，ＩＥ未能控制。其中８例于感染活动期行手术治疗；１３例于感染未完全获得控制时行手术治疗；２例心脏直视手术后发生霉菌性心内膜炎，经抗霉菌药物治疗无效，改用大蒜素治疗，效果满意。本组２１例施行手术治疗者无手术死亡，术后随访无复发病例。结论：感染性心内膜炎即使血培养阳性，亦应在大剂量有效抗生素保护下尽早手术。早期诊断、及时手术是控制感染。

Aim:Infective endocarditis is a complex disease process.The need for and timing of surgical intervention is still controversial.This retrospective study reviewed our experience of surgical treatment for infective endocarditis.Clinical material and method:From 1991 to 1995,23 patients with active infective endocarditis were treated in our department.There were 14 men and 9 women with a age ranged of 4 to 46 years.19 patients(83%)associated with congenital heart disease including ventricular septal defect in 9,atrial septal defect in 3,patent ductus arteriosus in 2,atrioventricular cannel defect in 3 and aneurysm of the aortic sinus in 2.Four patients(17%)associated with rheumatic heart disease(mitral valve insufficiency and stenosis in 2,aortic valve insufficiency in 2).All patients received previous treatment of antibiotics.All patients had preoperative Doppler echocardiography and vegetation was found in 21 patients(90%).Blood culture results were positive in 11 patients(47.8%).12 patients had heart failure and 2 had pulmonary embolism.The principle indications for operation were persistent sepsis despite adequate antibiotic therapy and sepsis to cardiogenic shock.21 patients received surgical treatment for infective endocarditis and primary heart disease(8 emergency operation and 13 elective surgery).Antibiotics were routinely used for 4 to 6 weeks postoperatively.2 patients developed myotic endocarditis after first open heart surgery and treated with allicinum.Results:There were no operative mortality and morbidity.All patients recovered uneventfully and return to normal life.During followup of 6 months to 5 years,there were no recurrence and late complications.Conclusion:This study suggest that surgical intervention and effective treatment of antibiotics for active infective endocarditis can achieve excellent outcome with low mortality and morbidity rates.Surgery should be considered when patients fail to respond to adequate levels of appropriate antibiotics.