感染性心内膜炎的诊断和外科治疗

Diagnosis and Surgical Treatment of Infective Endocarditis

目的总结感染性心内膜炎的临床诊断和外科治疗特点,提供临床治疗依据。方法回顾分析2000年11月-2008年3月苏州市立医院21例感染性心内膜炎外科手术的临床资料,男性14例、女性7例,年龄23～55岁,平均(44.36±12.45)岁,术前心功能(NYHA)Ⅱ级3例、Ⅲ级10例、Ⅳ级8例,左室舒张末期直径平均(64±10)mm。手术行主动脉瓣置换2例,二尖瓣置换9例,双瓣置换(主动脉瓣和二尖瓣)10例,其中急诊手术7例。伴行手术包括:主动脉窦瘤破裂修补2例,三尖瓣成形手术6例,主动脉瓣十脓肿清除心包片隔绝术2例,房缺修补2例,剖宫产后急诊二尖瓣替换1例。术后应用足量敏感抗菌素6～8周。结果手术死亡2例(住院30d内),手术死亡率10%,1例死于术后1周脑血管畸形破裂出血,另一例因术后多脏器功能衰竭,19例随访3月～6年,平均36.4个月,1例术后2月完全心脏阻滞放置永久起搏仪。术后心功能(NYHA):Ⅰ级15例,Ⅱ级4例。左室舒张末直径平均(54±6)mm,无晚期死亡。结论感染性心内膜炎在内科治疗效果差,早期诊断早期手术可取得良好效果,虽然急诊手术具有病情危重、手术难度大、手术死亡率高、并发症多等,但只要围术期处理得当,效果仍是良好。

Objective To summarize the clinical diagnostic and surgical treatment experience of infective endocarditis （IE） and provide evidence for clinical therapy. Methods From Nov. 2000 to Mar. 2008,21 （IE） patients that underwent heart operation in Suzhou Municipal Hospital were reviewed. There were 17 males and 4 females ,with an average age of 44.36 ± 12.45 years old. Pre-operative cardiac function classification（NYHA） ：class Ⅱ was in 3 cases,class Ⅲ in 10 cases and class Ⅳ in 8 cases. The operation including： aortic valve replacement （AVR）was performed in 2 cases, aortic and mitral valve replacement in 10 cases, mitral valve replacement in 9 cases and combined by operation including： ruptured sinus of Valsalva aneurysm were repaired in 2 cases, ASD repaired in 2 cases, TVP in 6 cases. Of the cases, emergent operation were performed in 7 cases. Enough dose of antibiotics were used for 6-8 weeks. Results 2 patients were dead because of celebral bleeding with endocelebral vessels abnormal and MOF in postoperative. There were no late death and no recurrence when followed up 3 months to 6 years（ an average of 36.4 months）. Postoperation heart function（NYHA） ：class Ⅰ was in 15 cases,class Ⅱ 4 cases. Conclusion Surgical treatment was effective for infective endocarditis. Early diagnosis, optimal surgical timing, combined internal medicine and surgical treatment provided good therapeutic effect of IE.