感染性心内膜炎病理解剖和外科治疗特点  

Pathological morphology and surgical therapy of infective endocarditis.

作　　者：任书南[1] 邱兆崑[1] 龚宝生[1] 郑知非[1] 

机构地区：[1]上海市胸科医院心外科,200030

出　　处：《中华胸心血管外科杂志》2001年第5期269-271,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的　探讨感染性心内膜炎病理解剖特点与外科治疗经验。方法　 1990年 9月至 1999年 11月间 ,连续 5 4例感染性内膜炎病人接受外科手术治疗。全组均符合修正VonReyn感染性心内膜炎诊断标准。男 33例 ,女 2 1例 ;年龄 15～ 6 3岁 ,平均 (36 5± 11 3)岁。术前血培养 36例 ,阳性 2 1例(5 8 3 % ) ,以链球菌 (15例 )、葡萄球菌 (5例 )为主。 5 2例坏死组织或赘生物光镜病理提示 ,组织坏死、钙化、肉芽肿和淋巴及中性粒细胞浸润。病理改变以赘生物和瓣膜穿孔常见 ,常累及左心系统瓣膜。瓣膜脓肿和腱索断裂少见。活动期急诊手术 18例 ,其中充血性心衰 13例 ,难治性败血症 5例 ;稳定期择期手术 36例。手术原则 :清除所有感染灶 ,纠治瓣膜病变及合并畸形。结果　本组无手术死亡。术后严重并发症包括败血症 2例、多器官功能衰竭 2例。随访 35例 (6 4 8% ) ,随访期 1～ 85个月 ,平均 (30± 2 5 )个月。 2例二尖瓣置换术病人分别在术后 1年、3年再次感染 ,死于充血性心衰和败血症。余 33例无感染复发 ,远期疗效良好。术后 1年、3年、7年生存率分别为 96 6 %、89 1%、89 1%。结论　感染性心内膜炎早期诊断 ,适时外科手术和内。Objective: This paper is to discuss a series of pathological features of infective andocarditis and summarize the experience of surgical therapy. Methods: A retrospecive review was compiled of 54 consecutive patients who fulfilled the modified Von Reyn criteria for the diagnosis of endocarditis from Sep. 1990 to Nov. 1999. It included 33 male and 21 female patients aged 15-63 years. Streptococcal species(71 4%) and staphylococcus(23 8%) were the most common organisms found by blood culture. Vagetations and valve perforations were commonly present in left heart valve. Valvular abscesses and ruptured chordae tendineae were encountered in 2 and 4 patients, respectively. 18 patients underwent operations at active phase, because of unremitting congestive heart failure(13) and uncontrolled sepsis(5), as others did with infection controlled. The principles of surgical approach are ① to eradicate infected tissue. ② to correct valvular disfunction and/or all the associated defects. Results: There were no operative mortality and morbidity. The serious perioperative complication were sepsis (2) and multiorgan failure (2). 35 of 54 (64 8%) were followed up for one month to 85 months. There were 2 late deaths. Persistent and recurrent sepsis was the common single cause of death. Short and long term result of the other 33 patients shows substantial improvement in functional performance and clinical status. Postoperative survival at 1 year, 3 year, 7 year were 96 5%, 89 1% and 89 1%,respectively. Conclusion: Early diagnosis and aggressive medical therapy are necessary combined with well timed surgical therapy.

关 键 词：心内膜炎 病理学 外科手术 

分 类 号：R654.2[医药卫生—外科学]