感染性心内膜炎患者的临床特点及外科治疗分析

Clinical characteristics of patients with infective endocarditis and analysis of surgical procedures

目的探讨感染性心内膜炎患者的临床特点及外科治疗情况,为临床合理诊治提供依据。方法对2008年1月-2012年12月收治的68例行外科手术治疗的感染性心内膜炎患者进行回顾性分析,分析患者的一般资料、血培养病原学种类、超声心动图改变及外科治疗效果、预后等。结果感染性心内膜炎主要的临床特征为发热及心脏听诊有杂音;68例感染性心内膜炎患者中血培养阳性39例,阳性率为57.35%,病原菌以链球菌属为主,占46.15%;其次为葡萄球菌属等,真菌较少见,仅占5.13%;64例治愈好转,好转率94.12%,2例自动出院,2例死亡,其中1例死于心力衰竭,1例死于顽固室性心律失常。结论早期诊断,术前积极的抗感染,适当的手术时机、完善的手术矫治和内外科的联合治疗可有效控制心功能的损害,提高患者生存率和治愈率。

OBJECTIVE To explore the clinical characteristics of the patients with infective endocarditis and understand the surgical procedures so as to provide guidance for reasonable diagnosis and treatment.METHODS A total of 68cases of patients with infective endocarditis,who received the surgical procedures in the hospital from Jan 2008 to Dec 2012,were retrospectively analyzed,then the general data,the species of pathogens from blood culture,echocardiographic changes,effects of surgical procedures,and prognosis of the subjects were observed. RESULTS The major clinical manifestations of the patients with infective endocarditis included fever and heart auscultation with murmur.Of totally 68cases of infective endocarditis,39cases were with the blood cultured positive with the positive rate of 57.35%.Among the pathogens isolated,the Streptococcus spp was dominant（46.15%）, followed by the Staphylococcus spp,and the fungi were rare and only accounted for 5.13%.Totally 64cases were cured and improved with the improved rate of 94.12%,2cases were automatically discharged,and 2cases died, including 1case of death from heart failure and 1case of death from refractory ventricular arrhythmias. CONCLUSIONThe early diagnosis,preoperative treatment of infection,appropriate timing for surgical procedure, completed surgical correction,and integration with internal medicine and surgery treatment can effectively control the damage of cardiac function and improve the survival rate and cure rate.