人工心脏瓣膜置换术后感染性心内膜炎的外科治疗  

Surgical Treatment for Prosthetic Valve Endocarditis after Valve Replacement

作　　者：邱志兵[1] 陈鑫[1] 徐明[1] 石开虎[1] 蒋英硕[1] 肖立琼[1] 汪黎明[1] 郭子璜[1] 

机构地区：[1]南京医科大学附属南京第一医院南京市心血管病研究所心胸外科,南京210006

出　　处：《中国胸心血管外科临床杂志》2006年第6期386-388,共3页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：南京市医学重点科技发展基金资助项目(ZKX0404)

摘　　要：目的探讨人工心脏瓣膜心内膜炎(PVE)再次外科手术指征、手术时机和手术治疗要点。方法2000年2月至2005年7月,手术治疗PVE患者18例,回顾性分析其临床表现、治疗经过和预后情况。结果术后早期死亡3例(16.7%),死于中毒性休克1例,多器官功能衰竭2例。2003年以后手术的11例患者无手术死亡。术后发生呼吸功能不全6例,肾功能不全2例,经相应的处理治愈。随访15例,随访时间1个月至5年,PVE再次复发1例,经内科治疗无效,死于全身衰竭;其余14例患者均治愈,恢复正常工作;心功能Ⅱ级12例,Ⅲ级2例。结论PVE的外科治疗风险大,死亡率高,而正确掌握手术指征、把握手术时机、彻底清除感染组织和围术期正确应用抗生素是保障PVE再手术治疗成功的关键。Objective To investigate the reoperation indication,surgical timing and the key point of surgical treatment of prosthetic valve endocarditis （PVE） after valve replacement. Methods From February 2000 to July 2005,18 patients with PVE underwent surgery ,their clinical manifestation ,process of treatment and their prognosis outcome were analyzed. Results There were 3 patients （16.7 %） of early-death, 1 patient died of septic shock, and 2 patients died of multiple organ failure. Since 2003,there was no operative death for all 11 patients. There were 6 patients with respiratory insufficiency, 2 patients with renal insufficiency,which were recovered after treatment. The 15 survivors were followed up from 1 month to 5years. There was recurrence of infection in 1 patient who died after ineffective medical treatment. The other 14 patients recovered well. Conclusion It has high risk and high mortality for reoperation for PVE. Accurate reoperative indication,optimal surgical timing,radical debridment of infected tissue and correct perioperative use of antibiotics are the key factors to improve the reoperative result for PVE.

关 键 词：人工心脏瓣膜 心内膜炎 再次手术 

分 类 号：R654.2[医药卫生—外科学]