人工瓣膜感染性心内膜炎的诊断与治疗  

Diagnosis and Treatment for Prosthetic Valve Endocarditis

作　　者：郑家豪[1] 薛松[1] 黄日太[1] 殷荣[1] 刘冀东[1] 朱洪生[1] 

机构地区：[1]上海交通大学医学院附属仁济医院心胸外科,上海200001

出　　处：《中国胸心血管外科临床杂志》2010年第5期377-380,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的总结人工瓣膜感染性心内膜炎（PVE）患者的治疗经验,对PVE的相关概念、致病菌、诊断及防治问题进行讨论。方法 1979年9月至2009年9月,我科共收治PVE患者33例,男17例,女16例;年龄19-57岁,平均年龄34岁。PVE的发生率为1.48%（33/2 236）,其中二尖瓣置换术（MVR）、主动脉瓣置换术（AVR）、双瓣膜置换术（DVR）和三尖瓣置换术后的PVE发生率分别为1.03%（16/1 551）、3.00%（7/233）、2.28%（10/438）和0%。行单纯内科疗法（青霉素或万古霉素联合其他抗生素抗感染,氟康唑、二性霉素抗真菌等）治疗22例;内、外科联合疗法治疗11例,经抗生素治疗、全身情况改善后择期手术,拆除感染的人工瓣膜后彻底清除周围的感染组织和赘生物,用抗生素、碘伏溶液及生理盐水反复冲洗;重新置换新的人工瓣膜。结果采用单纯内科疗法治愈3例（13.64%）,死亡19例（86.36%）。死于中毒性休克、心力衰竭9例,脑部并发症包括脑栓塞、脑出血、多器官功能衰竭10例;内、外科联合疗法治愈10例（90.91%）,死于多器官功能衰竭1例（9.09%）。随访13例,随访时间6个月-15年,平均41个月。随访期间除1例患者于术后8年发现二尖瓣人工机械瓣有瓣周漏手术修补外,其余12例随访患者无感染复发。结论内、外科疗法治疗PVE患者效果优于单纯内科疗法治疗。Objective To summarize the experiences of treatment for prosthetic valve endocarditis（PVE）,paying special emphasis on some interrelated conceptions of PVE,its microbiology,diagnosis,prevention and treatment. Methods From September 1979 to September 2009,33 patients diagnosed to have PVE were treated in our department.There were 17 males and 16 females.Their age ranged from 19 to 57 years old with an average age of 34 years.The incidence of PVE was 1.48%（33/2 236）including 1.03%（16/1 551）,3.00%（7/233）,2.28%（10/438）,and 0% of PVE in mitral valve replacement（MVR）,aortic valve replacement（AVR）,double valve replacement（DVR）,tricuspid valve replacement（TVR）,respectively.Pure medical treatment（Penicillin or Vancomycin with other broad-spectrum antibiotics,Fluconazole and Amphotericin） was performed on 22 patients.Combined medical and surgical treatment was performed in 11 patients.The patients underwent operation after adequate antibiotics treatment and general condition improvement.The infective tissue and vegetation were completely debrided after the infective prosthetic valve was removed.Before the new valve was transplanted,paravalvular tissue was cleaned with antibiotics,iodine solution and normal saline.Results Hospital death occurred in 19 patients（86.36%） and only 3 patients（13.64%） recovered in the group with pure medical treatment.The main reasons for death were infective shock and cardiac failure in 9 patients,and cerebral complications including embolism,bleeding and multiple-organ failure in 10 patients.For the group with combined medical and surgical treatment,10 patients（90.91%） survived and only one patient（9.09%） died of multiple-organ failure.Follow-up was done in 13 patients for 6 months to 15 years averaging 41 months.During the follow-up,only one patient was re-operated because of the paravalvular leak eight year later.There was no PVE recurrence in all the rest patients.Conclusion Compared with pure medical treatment,combined medical and surgi

关 键 词：人工瓣膜感染性心内膜炎 心瓣膜置换术 内 外科联合疗法 赘生物 

分 类 号：R654.2[医药卫生—外科学]