二尖瓣脱垂合并感染性心内膜炎的手术治疗  

Surgical treatment of mitral valve prolapse complicated by infective endocarditis

作　　者：杨新伟[1] 王志农[1] 徐志云[1] 张宝仁[1] 邹良建[1] 纪广玉[1] 张宇峰[1] 谭健[1] 

机构地区：[1]第二军医大学长海医院胸心外科,解放军胸心外科研究所,上海200433

出　　处：《第二军医大学学报》2009年第2期133-136,共4页Academic Journal of Second Military Medical University

摘　　要：目的:探讨手术治疗二尖瓣脱垂合并感染性心内膜炎的方法。方法:2000年6月至2007年12月手术治疗40例二尖瓣脱垂合并感染性心内膜炎患者,其中男性30例、女性10例;平均年龄39.2岁(13～63岁)。术前血培养阳性率为42.5%。超声心动图检查结合术后病理检查是诊断的主要方法。心功能(NYHA分级)Ⅱ级15例,Ⅲ级21例,Ⅳ级4例。手术行二尖瓣成形术5例,行二尖瓣置换术35例,均选用机械瓣。结果:早期死亡1例,死于肾功能衰竭。1例Ⅲ度房室传导阻滞需安装永久性心脏起搏器。出院检查体温均正常。长期存活39例,术后随访6个月～8年(平均2.7年),无晚期死亡,未见心内膜炎复发及瓣周漏。结论:对二尖瓣脱垂出现中到重度二尖瓣关闭不全且合并感染性心内膜炎时应早期治疗,术中彻底清除感染病灶和围术期应用大剂量敏感抗生素是提高手术效果和防止术后心内膜炎复发的关键。术中根据瓣膜情况,决定施行二尖瓣修复术还是二尖瓣置换术,二尖瓣置换术选用机械瓣治疗效果良好。Objective：To investigate the surgical procedure for mitral valve prolapse complicated by infective endocarditis. Methods： From June 2000 to December 2007,40 patients with mitral valve prolapse complicated by infective endocarditis received operation in our hospital. The patients included 30 males and 10 females,with a mean age of 39.2 years （ranging 13-63 years）. The positive blood culture rate was 42.5 % before operation. Combination of echocardiogram with post-operative pathology was the main method for diagnosis. The grades of cardiac function of the patients were in NYHA Ⅱ （15 cases）,Ⅲ （21 cases）and Ⅳ （4 cases）. Mitral valve repair was performed in 5 patients and mitral valve replacement was done in 35 cases, all with artificial mechanical heart valves. Results： One patient died of renal failure early after operation. One patient had complete AV block and received pacemaker implantation. All the patients had normal body temperature on discharge. During follow-up （mean 2.7 years, ranging 6 months to 8 years）,39 patients survived without later mortality, recurrence of endocarditis and paravalvular leakage. Conclusion： Surgical treatment for patients with mitral valve prolapse complicated by progressive moderate or severe mitral regurgitation and infective endocarditis should be performed as early as possible. Radical debridement of the infected tissues and application of sensitive and high dose of antibiotics are the keys for preventing postoperative endocarditis recurrence. Replacement or annuloplasty should be chosen according to the quality of the valve during surgery. The results of mechanical prosthetic valve are excellent.

关 键 词：感染性心内膜炎 二尖瓣脱垂 二尖瓣成形术 二尖瓣置换术 

分 类 号：R654.27[医药卫生—外科学]