外科治疗动脉导管未闭合并感染性心内膜炎

Analyssi of surgical treatment in patent ductus arteriosus and infectious endocarditis

目的研究动脉导管未闭(PDA)合并感染性心内膜炎(IE)的诊断、手术指征、手术时机及手术方式的选择,观察手术效果,总结临床治疗经验。方法回顾性分析2000年1月至2012年9月接受手术治疗的36例PDA合并IE患者资料。所有患者均予血培养和超声心动图检查,并及时予外科手术治疗,术后充分地抗感染和心功能维护治疗。结果本组无围术期死亡。术后并发症主要有:低心排综合征2例,急性肾功能不全2例,肝功能损伤1例,短暂脑损伤1例。所有患者经积极治疗,均痊愈出院。结论 PDA合并IE这一严重的感染性疾病,血培养和超声心动图检查具重要的诊断价值;适时而彻底的外科手术治疗至关重要;术后继续充分地抗感染治疗和心功能维护治疗是取得良好疗效的保证。

Objective This study present the diagnosis,surgical indications,surgical timing and choice of surgical approach for patent ductus arteriosus（ PDA） and infective endocarditis （ IE） ,and observatie results of operations,summarize the clinical experience. Methods The retrospective analysis enrolled 36 patients of PDA combined IE from January 2000 to September 2012 underwent surgery. All patients were with blood cultures and echocardiography,timely surgical treatment and postoperative anti-inflammatory and cardiac function maintenance therapy. Results There were no perioperative death. Postoperative complications were： low cardiac output syndrome in 2 cases,acute renal failure in 2 cases,liver injury in 1 cases,upper gastrointestinal bleeding in 1 cases. After active treatment,36 patients were cured and discharged. Conclusion PDA combined IE is a serious infectious circulatory system diseases,then blood cultures and echocardiography have the important diagnostic value of it. Timely and complete surgical treatment is essential,and continued anti-inflammatory and cardiac function maintenance therapy have maintain the efficacy of treatment.