感染性心内膜炎瓣膜损害的诊断及手术效果

Effect of surgery of valve lesions caused by infective endocarditis

目的:回顾性分析感染性心内膜炎瓣膜损害的诊断方法和手术效果。方法:2000年1月至2008年5月之间行手术治疗的感染性心内膜炎瓣膜损害者共119例,术前均进行血培养和彩色超声心动图检查。急诊手术32例,择期手术82例,所有病人经外科手术彻底清除感染病灶及周围坏死组织,纠正心内畸形,施行瓣膜置换。结果:术前超声发现赘生物115例(96.6%),瓣膜穿孔20例(16.8%),血培养结果阳性32例(26.9%);术中发现心内赘生物115例,穿孔21例,与术前超声检查结果无显著差异(P>0.05);术后死亡5例(4.2%),其中急诊术后早期死亡2例(6.25%),择期术后早期死亡3例(3.66%),两组死亡率无显著性差异(P>0.05)。结论:超声心动图检查可作为临床上确诊感染性心内膜炎的重要依据,对已确诊的患者应努力控制感染并尽早手术。

Objective： To retrospectively analyze the diagnosis, effect of surgery of valve lesions caused by infective endocarditis. Methods： A total of 119 cases of valve lesions caused by infective endocarditis in our hospital from January 2000 to May 2008 were selected, all the patients received blood culture and UCG examination. The 32 cases operated with emergency （emergency group） and 82 cases operated with select time （select group）. Thorough eliminate of in- fected tissue and necrotic issue, correction of cardiac abnormalities and valve replacement were done for all the patients. Results： The 115 cases with vegetation （96.6%） and 20 cases with valve perforation （16.8%） in UCG examination. The 32 cases were positive in blood culture （26.9 % ）. Vegetations were found in 115 cases, and perforation in 21 cases by operation, it showed no significant difference to preoperative UCG examination （P〉0.05）. Five cases died after operation （4.2%）, in which two cases died in emergency group （6. 25%） and three cases in select group （3.66%）, there was no significant difference between two groups （P〉0.05）. Conclusion： UCG examinations may be an impor- tant method for clinically diagnosing infective endocarditis. For diagnosed patients should control the infections and take operation as soon as possible.