人工心脏瓣膜心内膜炎的外科治疗  

Surgical treatment for prosthetic valve endocarditis

作　　者：陈金淼[1] 洪涛[1] 王春生[1] 赵东[1] 宋凯[1] 潘荪[1] 

机构地区：[1]上海复旦大学附属中山医院心外科,200032

出　　处：《中华胸心血管外科杂志》2015年第2期65-68,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 总结人工心脏瓣膜心内膜炎（prosthetic valve endocarditis,PVE）的临床特点和外科治疗经验.方法 2003年1月至2012年12月,20例PVE患者在我院接受心脏手术.体外循环下去除感染的人工心脏瓣膜,彻底清除感染组织并重建心脏结构.全组共行Bentall术6例,改良Cabrol术4例,主动脉瓣置换术4例,二尖瓣置换术3例,双瓣置换术3例.结果 术后早期（30天内）死亡1例,死于感染导致的多器官功能衰竭,其余19例均治愈出院.2例真菌PVE于术后2个月和4个月复发,内科治疗无效死亡.其余随访14例,随访时间20～124个月,平均（59.0±31.8）个月,无复发和死亡.结论 正确掌握手术指征和手术时机、彻底清除感染组织,是PVE手术成功的关键.Objective To report the clinical characteristics and surgical treatment of prosthetic valve endocarditis （PVE）.Methods A retrospective review of 20 consecutive patients,who underwent surgery for PVE between Jan 2003 and Dec 2012,was conducted.Excision of infected prosthetic valves and radical debridement of the infected tissues were completed under hypothermic cardiopulmonary bypass.Six patients were treated by the Bentall procedure,4 patients by the modified Cabrol procedure,4 patients by aortic valve replacement,3 patients by mitral valve replacement and 3 patients by double valve replacement.Results One patient died within 30 days after surgery due to severe sepsis complicated with multiple organ failure and other 19 patients discharged smoothly.A further 2 patients died 2 and 4 months after surgery due to recurrence of fungal infection.Fourteen patients were followed up for 20-124 （59.0 ± 31.8） months.No patient died and no relapse of endocarditis occurred during the period of follow-up.Conclusion Optimal timing of surgical intervention and radical debridement of all infected tissues are the keys to success.

关 键 词：人工心脏瓣膜 感染性心内膜炎 心脏外科手术 

分 类 号：R654.2[医药卫生—外科学]