感染性心内膜炎不同手术时机外科治疗的方案效果比较

Surgical treatment for infective endocarditis

目的回顾性分析感染性心内膜炎治疗细节及临床转归,总结感染性心内膜炎的不同时间点手术治疗的具体治疗方案和近期临床效果.方法回顾性分析2010-2018年成都市第三人民医院心脏大血管外科收治的准备行外科手术的感染性心内膜炎患者84例,其中男性53例、女性31例,年龄16~76岁.A组61例,完成4周抗感染疗程,并完成手术.B组:未完成抗感染组23例(B1组:急诊或亚临床急诊手术组19例,未完成术前4周抗感染,完成手术者;B2组:术前死亡4例,未行手术者);分析各组患者治疗及预后情况.结果①全组血培养阳性率为32.1%,A组血培养阳性率(26.2%)低于B1 (42.1%)、B2(75%)组,差异有统计学意义(P<0.05);A组以链球菌属最常见(50%),B组细菌毒力较A组增加.②A组与B1组死亡率(3.28%比5.26%)比较未见统计学差异.A组与B组死亡率(328%比21.7%)比较差异有统计学意义.③A组与B1组在ICU治疗时间(53 h比79 h)、并发症发生率(4.9%比10.52%)比较差异有统计学意义.结论①感染性心内膜炎确诊后,如伴有瓣膜功能受损、心功能受损、赘生物形成、感染无法控制、近期发生的肢体栓塞者应急诊手术治疗,手术死亡风险可控.②精准、高强度、全覆盖式抗感染治疗为感染性心内膜抗感染治疗的模式.③对于感染性心内膜炎手术指征把握应该更加灵活,果断,手术治疗应更加积极.

Objective To investigate the recent clinical effects of various specific treatment schemes on infective endocarditis. Methods 84 patients with infective endocarditis who were admitted to the department of cardiac macrovascular surgery in the third people's hospital of Chengdu from 2010 to 2018 were retrospectively analyzed. Among them, 53 were males and 31 were females with age 16-76 years old. Group A, 61 patients were given 4 weeks anti-infection and then operated. Group B: patients had not were given anti-infection group 4 weeks (group Bl: emergency or subclinical emergency operation group, who have not finished anti-infection 4 weeks before surgery, a total of 19 patients;group B2: death before operation, 4 cases without operation). The treatment effect and prognosis of patients in each group were analyzed. Results (l)The total positive rate of blood culture was 32.1% in 2 groups. The positive rate of group A (26.2%)was lower than that in group Bl (42.1%) and B2 (75%), with statistical significance (P<0.05 ). Streptococcus was the most common pathogen in group A (50%), and bacterial virulence in group B was higher than that in group A.(2)There was no significant difference in mortality between group A and group Bl ( 3.28% vs. 5.26%). There was significant difference in mortality between group A and group B( 3.28% vs. 21.7%).(3)There were significant differences in ICU time (53 hours vs. 79 hours)and complication rate between group A and group Bl (4.9% vs. 10.52%). Conclusion (l)After the clear diagnosis of infective endocarditis. patients with valvular dysfunction, cardiac dysfunction, vegetation formation. uncontrollable infection and recent limb embolism should be treated by emergency surgery and the risk of surgical death can be controlled.(2)Accurate, high-intensity, full-coverage anti-infection treatment should be the mode of anti-infection treatment of infective endocardium and the course of treatment must be sufficient.(3)Grasping the surgical indications of infective endocarditis should be more flexible and decisive and surgical treatment should be more active.