瓣膜置换术后感染性心内膜炎的外科治疗

Infectious endocarditis after valve replacement surgery

目的分析瓣膜置换术后感染性心内膜炎（PVE）的临床特点、外科手术方法和疗效，总结围手术期处理经验。方法2000年1月至2011年12月，共再次手术治疗PVE患者17例，回顾性分析其临床表现、诊治经过和预后情况。结果术后早期死亡2例（11．76％），死于感染性休克1例、多器官功能衰竭1例。术后发生低心排综合征2例，肾功能不全2例，呼吸功能不全2例，均经治愈后出院。随访14例，随访时间3个月至9年，生存良好，无复发。结论PVE的外科治疗风险大，死亡率高，正确掌握手术指征、术中彻底清除感染灶和围术期正确处理是提高手术成功率的关键。

Objective To study clinical characteristics, surgical methods and curative effect of infective endocarditis after valve replacement （PVE） and summarize the perioperative management experiences. Methods From January 2000 to December 2011, a total of 17 cases of reoperation treatment of PVE were retrospective ana-lyzed of its clinical manifestation, diagnosis and treatment and the prognosis. Results Early death was 2 cases （11.76%）, 1 case died of septic shock, 1 case of multiple organ failure. Low cardiac output syndrome after oper-ation was 2 cases, 2 cases of renal insufficiency, 2 cases of respiratory insufficiency, were all been cured and discharged. 14 cases were follow-up for 3 months to 9 years, there was no recurrence. Conclusion PVE has high surgical risk and high mortality. Proper surgical indication, complete removal of focal infection in surgery and peri-operative handling correctly are the key to improving the surgical success rate.