原发性感染性心内膜炎的临床分型和外科处理  

Clinical Classification and Surgical Treatment of Native Infective Endocarditis

作　　者：马建旸[1] 石应康[1] 张尔永[1] 肖锡俊[1] 董力[1] 杨建[1] 安琪[1] 程述森[1] 

机构地区：[1]四川大学华西医院胸心外科,四川成都610041

出　　处：《华西医学》2006年第2期235-236,共2页West China Medical Journal

摘　　要：目的：探讨原发性感染性心内膜炎的临床分型特点，分析影响手术近期预后的危险因素。方法：对109例外科手术治疗的原发性感染性心内膜炎患者进行回顾性分析。根据手术前感染情况，分为感染活动型、感染静止型、和感染隐匿型，比较三组患者间围手术期临床特征和预后情况。结果：感染活动型患者具有基础心脏病史比例显著低于感染静止型和感染隐匿型患者，而其血白蛋白、血白细胞等血液指标异常率、急诊手术治疗的比例和术后并发症发生率均显著高于感染静止型和感染隐匿型患者。三组患者手术死亡率无显著性差异。与生存组相比，死亡组患者中NYHA心功能Ⅲ～Ⅳ级、血沉异常、急诊手术及术后并发症的比例显著增高。结论：不同临床分型的原发性感染性心内膜炎患者经早期诊断、正确选择手术时机和手术方法、以及良好的围手术期处理，均能获得较满意的手术疗效。Objective： To evaluate the clinical classification of native infective endocarditis and analyze the risk factors influerring the short - term prognosis of surgical treatment. Methods： One - hundred and nine patients undergoing surgical treatment for native infective endocarditis were retrospectively studied. According to their preoperative infective status, they were divided into 3 groups; （1） active infection; （2） quiescent infection; and （3） obscure infection. The perioperative clinical characteristics and prognosis of the patients in the 3 types were compared. Results： The predisposition rate of active infection group was significantly lower than the other two groups. The hematological abnormal rate （albumin and white blood cell）, positive blood culture rate, emergency surgery rate, and surgery morbidity of the active infection group were significantly higher than the other two groups, but the surgical morrality of the 3 types showed to statistical difference. The NYHA Ⅲ～Ⅳ percentage, abnormal erythrocyte sedimentation rate, emergency sm＇gery rate and surgery morbidity of non- survivors were significantly higher than that of the survivors. Conclusion： Native infective endocarditis patients of different clinical classifications would have surgical results if the operation was carried timely and in correct way, and the perioperative treatment was adequate.

关 键 词：原发性感染性心内膜炎 临床分型 外科治疗 

分 类 号：R654.2[医药卫生—外科学]