急性重症感染性心内膜炎的外科治疗效果分析

Surgical Treatment for Severe Acute Infective Endocarditis

目的:评价急性重症感染性心内膜炎的外科手术治疗效果,探讨其临床治疗的意义。方法:对2010年2月-2014年8月来我院就诊的36例重症心内膜炎患者的临床资料进行回顾性分析,均诊断为原发性心内膜炎,包括感染侵犯主动脉瓣12例,二尖瓣17例,同时感染侵犯二尖瓣和主动脉瓣的7例。手术治疗中发现主动脉瓣周围出现脓肿的1例,瓣叶严重受损的28例,且均发现有瓣膜赘生物的生成。清除脓肿后采用主动脉瓣替换治疗的12例,二尖瓣替换治疗的17例,间断褥式缝合的2例,同时采用主动脉瓣和二尖瓣的双瓣替换治疗的5例。结果:在治疗的早期没有出现死亡病例,手术治疗4个月后采用NYHA分级法对心功能进行评价,恢复至Ⅰ级的36.11%(13/36)、Ⅱ级63.89%(23/36)。结论:重症心内膜炎中瓣环和瓣膜毁损严重的患者如果能够积极进行手术,彻底清除心脏周围的赘生物,及时恰当处理好病灶的创面,对手术本身是否能完全成功和手术治疗后的近期恢复效果至关重要。

Objective：To discuss the efficacy of the operation therapy for severe acute infective endocarditis（IE） .Meth-ods：The data of 36 cases of IE treated by surgery were analyzed retrospectively from February 2010 to August 2014 .In this research ,36 patients suffered primary infective endocarditis ,12 cases were aortic valve infection ,and 17 cases were mitral valve infection ,while both mitral and aortic valves were involved in 7 cases .During surgery ,mitral valve annu-lus abscess in 1 patient ,and seriously damaged valve was found in 28 patients .All patients had valvular vegetations formed .After using clear abscess treatment ,12 patients were conducted aortic valve replacement therapy ,mitral valve replacement was found in 17 cases ,interrupted mattress suture therapy in 2 cases ,while 5 patients were taken aortic and mitral valve replacement therapy .Results：There is no death happened in early postoperative .The cardiac function of each patient was classified by NYHA method ,and the percentage of Ⅰ level patient was 36 .11% （13/36） ,while the percentage of Ⅱ grade was 63 .89% （23/36） after 4 months surgery .Conclusion：For severe acute infective endocarditis （IE） patients ,early surgical intervention is the key to postoperative infection control and better prognosis of the dis-ease ,which can eliminate the valvular vegetations forming ,appropriate handle the lesions wounds.