室间隔缺损合并感染性心内膜炎40例诊疗分析

Diagnosis and treatment of ventricular septal defect with infective endocarditis in 40 patients

目的分析室间隔缺损合并感染性心内膜炎的诊疗情况。方法回顾性分析2001~2016年于我院就诊的40例室间隔缺损合并感染性心内膜炎患者的临床资料,其中男25例、女15例,年龄20~62(39.92±11.16)岁。根据入院至手术时间将其分为两组:A组为早期手术组,入院7 d内行手术治疗;B组为常规治疗组,入院至手术时间>7 d。其中A组患者27例,男15例、女12例,平均年龄(39.56±11.80)岁;B组患者13例,男10例、女3例,平均年龄(40.69±10.13)岁。所有患者均进行超声心动图及血液细菌培养等检查,了解其病原学、超声心动图结果及治疗情况,并比较两组患者的临床资料。结果B组患者术前死亡2例,1例死于心功能衰竭,1例死于脑梗死,余患者无围手术期死亡。住院期间无再次手术,无脑梗死、血栓栓塞等并发症。A组患者呼吸机使用时间显著短于B组[(18.00±14.85)h vs.(31.00±29.57)h,P=0.015]。两组患者体外循环时间、心肌阻断时间和术后住院时间差异无统计学意义(P>0.05)。患者出院后继续抗生素治疗3~6周。随访时间12~127(75.74±6.01)个月,随访期间A组患者1例死于恶性肿瘤,B组患者1例出现心功能不全,1例出现心房颤动,余患者未诉明显不适。术后复查室间隔缺损部位无残余分流,无感染性心内膜炎复发、再次手术、术后脑卒中、血栓栓塞事件发生。结论术前超声心动图及血液细菌学培养有助于室间隔缺损合并感染性心内膜炎患者的诊断及治疗方案的制订,对这部分患者早期进行手术治疗是安全有效的,并可提高患者的远期生存率。

Objective To analyze the diagnosis and treatment of patients with ventricular septal defect complicated with infective endocarditis.Methods We retrospectively analyzed the clinical data of 40 patients with ventricular septal defect complicated with infective endocarditis in our hospital from 2001 to 2016.There were 25 males and 15 females,aged 20-62(39.92±11.16)years.They were divided into two groups according to the duration from admission to surgery:a group A(an early operation group whose surgery was performed within 7 days after admission)and a group B(a conventional treatment group with the duration from admission to surgery>7 days).Among them,there were 27 patients in the group A including 15 males and 12 females with an average age of 39.56±11.80 years,and 13 patients in the group B including 10 males and 3 females with an average age of 40.69±10.13 years.All patients were examined by echocardiogram and blood bacterial culture to investigate their etiology,echocardiogram results and treatment status.And the clinical data of the two groups were compared.Results Two patients died before operation in the group B,one died of heart failure,and one cerebral infarction.No reoperation during hospitalization,cerebral infarction,thromboembolism or other complications occurred.The ventilation time in the group A was significantly shorter than that in the group B(18.00±14.85 h vs.31.00±29.57 h,P=0.015).There was no statistical difference in the extracorporeal circulation time,myocardial block time,or postoperative hospital stay between the two groups(P>0.05).After discharge,the patients continued antibiotic therapy for 3-6 weeks.Patients were followed up for 12-127(75.74±6.01)months,1 died of malignant tumors in the group A,1 developed atrial fibrillation and 1 developed cardiac insufficiency in the group B,and the rest of patients did not complain of obvious discomfort.There was no residual shunt,recurrence of infective endocarditis,reoperation,postoperative stroke or thromboembolism.Conclusion Preoperative echocardiography and blood bacteriological culture are helpful for the diagnosis and treatment of patients with ventricular septal defect complicated with infective endocarditis.Early surgery is safe and effective for these patients,and can improve the long-term survival rate.