41例感染性心内膜炎个案化处理

Individual treatment on 41 cases of infective endocarditis

目的:报告41例感染性心内膜炎(infective endocarditis,IE)个案化处理的经验。方法:本组病例共41例,占同期住院患者(1682例)2.38%。其中男性33例、女性8例,病种分布为主动脉瓣病变7例(穿孔3例),二尖瓣病变6例,肺动脉病变2例,主动脉窦瘤2例,主动脉根部脓肿1例,先心病合并心内膜表面炎性病变者17例。心脏手术后8例。在所有针对IE手术治疗患者中,急性IE3例,亚急性IE5例,IE稳定期后遗症处理25例(术中发现IE病变7例)。血培养阳性9例,赘生物15例,脓肿2例,赘生物与脓肿培养阳性10例,菌种分布为金黄色葡萄球菌、真菌、草绿色链球菌及阴沟肠杆菌。继发IE病例中心脏手术后IE6例,原发IE32例术前均应用抗生素、改善心功能等处理,其中感染被控制或炎症静止期手术27例;急诊手术4例。结果:本组围术期死亡2例,均因严重心力衰竭难以纠治。远期再发急性IE瓣周漏自动出院1例。门诊检查及随访资料显示轻度主动脉瓣周漏和瓣膜反流各1例,无临床症状与血流动力学影响。随访患者中除1例心功能Ⅳ级外,心功能均恢复至I级。结论:抗生素应用和手术治疗的个案化处理,二者紧密结合是提高IE疗效的关键。

Objective：We aim to evaluate the clinical characteristics and outcome of infective endocarditis in our hospital.Methods：A retrospective review of all 41 cases of infective endocarditis（IE） was undertaken,male 33,female 8.There was 2.38% in all inpatient（1682） at same time.The spectrum of diagnostic was aortic valve disease（AVR,7）,mitral valve disease（MVR,6）,pulmonary（2）,aneurysms of the sinus of Valsalva（1）,abscesses in root of artery（1）,concomitant with congital heart diseas（CHD,17）,postoperation IE（8）.In all patients treated by operation,there are acute IE 3,subacute IE 5 and stable 25.There were 9 cases positive blood culture results.There were 15 neoplasms and 1 abscesses found in operation.There were 10 positive tissue culture results for these samples.For the patients dentified as primary IE,a course of intravenous（Ⅳ） antibiotic therapy and improving heart function were started except for 4 emergency operation.Results：2 patients died during postoperation since heart failure.Another patient gived up therapy for leak of perivalve with serious heart failure during follow-up.In all other follow-up in out-patients,heart function were normal excluding one serious heart failure in long term.Conclusion：Individual of antimicrobial treatment schemes and operation programme,as well as both reasonable coordinate,were critical for outcome of IE.