感染性心内膜炎的外科手术治疗  

Surgical treatment of infective endocarditis

作　　者：刘兴荣[1] 苗齐[1] 于洪泉[1] 任华[1] 王振捷[1] 马国涛[1] 曹丽华[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院心外科,100730

出　　处：《北京医学》2005年第9期519-521,共3页Beijing Medical Journal

摘　　要：目的总结手术治疗感染性心内膜炎的经验。方法回顾分析手术治疗43例感染性心内膜炎患者的临床资料。术前血培养阳性22例。感染累及左心系统35例,累及右心系统7例,同时累及左右心系统1例。手术均在体外循环下进行,行瓣膜替换33例,其中4例并发主动脉根周脓肿者行同种瓣主动脉根部置换,使用机械瓣26例。行二尖瓣成形2例,三尖瓣成形6例,室间隔缺损修补3例。结果术后30d内死亡2例,二次开胸止血1例;成人呼吸窘迫综合征5例;术后使用主动脉气囊反博术(IABP)4例;植入永久起搏器2例。存活41例全部获得随访,平均随访(46.8±22.3)个月。随访期间无远期死亡,无再次感染,心功能明显改善。结论外科手术是治疗感染性心内膜炎的有效手段。Objective To review our experience in surgical treatment of infective endocarditis. Methods Fortythree consecutive patients with infective endocarditis were subjected to surgical management between 1998 and 2004, 26 were male, 17 were female and the mean age was 40.1±14.9 years. Pre-operative blood culture was positive in 22 pa- tients. Thirty-five patients had isolated left heart infection, 7 had isolated right-heart infection and 1 had both-sided infection. Pre-operative systemic embolic events occurred in 4 patients, and high degree atrioventricular block in 3 patients. 27 patients had to be operated in the active phase of infection, including 13 urgent operations because of intractable heart failure. Valve replacement was performed in 33 patients,valvuloplasty in 8 patients, and VSD closure in 3 patients. Cryopreservated aortic homografts were used in 4 patients, mechanical prostheses were implanted in 26 patients. Results Two early deaths occurred in this group. Post-operative morbidities included： re-operation for bleeding in 1 patient, complete atrioventricular block rendering permanent pacemaker implantation in 2 patients, and adult respiratory distress syndrome in 5 patients. All survivors were followed up for a mean interval of 46.8-＋22.3 months. No late death or recurrent infection occurred, and all were significantly improved in NYHA functional class. Conclusions Our data suggests that in case of endocarditis, aggressive surgical treatment combined with medical therapy can optimize patients＇clinical outcome. Proper timing of operation, appropriate operative strategy and intensified peri-operative management are essential for good outcome.

关 键 词：感染性心内膜炎 手术治疗 主动脉气囊反博术 瓣膜置换术 心功能 

分 类 号：R654.2[医药卫生—外科学]