感染性心内膜炎急诊外科治疗

Urgent surgical intervention for infectious endocarditis

目的 报告一组感染性心内膜炎病人行急诊外科治疗的经验。方法 36例病人中 ,34例次 (94% )有赘生物 ,19例次 (5 2 % )瓣膜穿孔 ,2 9例次 (81% )严重瓣膜关闭不全 ,均在体外循环下行紧急外科手术 ,切除和清除感染瓣膜、组织、赘生物。用 0 2 %呋喃西林、先锋霉素溶液反复冲洗 ;置入机械瓣 ,矫治心内畸形。结果 33例恢复出院 ,包括 2例术前因进行性充血性心力衰竭、休克 ,心跳骤停 ,在心肺复苏、呼吸机辅助下行急诊瓣膜置换手术者。 3例术后死亡 ,病死率为 8 3%。 1例死于心力衰竭及多器官功能衰竭伴III度房室传导阻滞 ,2例死于严重低心输出量综合征及急性肾功能衰竭。 36例术后病理证实为感染性心内膜炎。结论 感染性心内膜炎出现进行性充血性心力衰竭和感染不能控制时 ,赘生物需接受紧急外科手术治疗 ;紧急手术不会使感染灶扩散 ;

Objective To review the experience of urgent surgical intervention for infectious endocarditis. Method A total of 36 patients with infectious endocaditis received urgent surgical intervention under cardiopulmonary bypass. Infected valves were excised, debrided and repeatedly flushed with 0 2% furacililin and cefazolin solution. Mechanical valve was implanted and cardiac abnormalities were corrected. Result 19 patients had valvular perforation, pannus in 34, severe regurgitation in 29. Thirty four of 36 patients recovered and discharged. Three patients died postoperatively with mortality rate of 8%. One died from progressive congestive heart failure and multiple organ failure, another two died from multiple organ failure. Conclusion Mechanical valve replacement can achieve good result in active infectious endocarditis patient with progressive congestive heart failure and uncontrolled infection.