外科治疗感染性心内膜炎  

The surgical treatment of infective endocarditis

作　　者：陈锁成[1] 丁国文[1] 王黎铭[1] 尹俊[1] 施益军[1] 

机构地区：[1]江苏大学附属人民医院心胸外科,镇江市212002

出　　处：《中国心血管病研究》2008年第8期609-611,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的总结56例外科治疗感染性心内膜炎(IE)的经验。方法全组56例,男性43例,女性13例,年龄10～75岁,病史5d至8个月,平均1.3个月。临床表现均有程度不等的发热、心悸、气急等症状,其中急性心衰伴进行性加重不能控制者19例、脾肿大及皮肤出血18例、持续高热不退者15例、动脉栓塞者7例、传导阻滞者4例、血培养阳性者15例。全组均在体外循环下施行心内直视手术,其中左房室瓣置换24例、双瓣膜置换19例、主动脉瓣置换7例、右房室瓣成形3例、右房室瓣置换2例、Bentall手术1例,同期矫治合并其他心血管畸形8例。急诊手术占34%(19/56)。结果早期死亡4例(7.2%),其中3例为低心排综合征,1例为人工瓣膜感染性心内膜炎;晚期死亡2例。长期存活50例,心功能均为Ⅰ～Ⅱ级。结论对IE应积极手术治疗,尤其需要在血流动力学及瓣膜条件恶化前手术;急性心衰伴进行性加重不能控制者外科治疗仍有较理想手术疗效。Objective To summarize the surgical treatment experience of 56 cases infective endocarditis. Methods It included 43 male and 13 female patients aged 10-75 years. The duration of disease was 5 days to 8 months （averaged 1.3 months）. Patients had different degree fever, palpitation, short breath, et al. There were 19 patients with acute progressive heart failure which couldn＇t be controlled and 15 patients with lasting high fever. And 7 patients had arterial embolism, and 4 patients had heart conduction block. Blood culture results were positive in 15 patients.All patients underwent intracardiac surgery under extracorporeal circulation.24 underwent left atrioventricular valve replacement, 19 underwent two valves replacement, 7 underwent aortic valve replacement, 3 underwent right atrioventricular valve shaping, 2 hayer right atrioventricular valve replacement, 1 underwent Bentall operation, 8 anisotrophies were corrected in synchronization. Emergency operations have the proportion of 340/0 （19/56）. Results 4 patients died at the initial stage（7.2%）. 3 died from low cardiac output syndrome of them and the other from artificial valve infective endocarditis. 2 patients died at the late stage. 50 patients survived with their heart function of NYHA Ⅰ - Ⅱ. Conclusion Surgical treatment has a good effect for infective endocarditis with acute progressive heart failure which couldn＇t be controlled. It is important that operation should be carried on before hemodynamics and valve condition going worse.

关 键 词：外科治疗 感染性心内膜炎 瓣膜损害 

分 类 号：R654.2[医药卫生—外科学]