重症感染性心内膜炎的外科治疗  

Management of cardiopulmonary bypass of refractory endocarditis

作　　者：王盛宇[1] 高扬[2] 刘新宾 高智强[2] 张国华[2] 赵忠[2] 

机构地区：[1]首都医科大学附属安贞医院心脏外科,北京市100029 [2]航天中心医院心脏外科

出　　处：《中国心血管病研究》2017年第1期34-36,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的 总结重症感染性心内膜炎（IE）的治疗体会.方法 自2008年10月至2015年4月航天中心医院手术治疗重症感染性心内膜炎患者15例.术前常规抗生素治疗2～4周,均在全麻浅低温（28℃～32 ℃）下行瓣膜置换术,心肌保护采用4：1含血停跳液灌注或HTK液,采用连续大容量平衡超滤（4000～6000 ml）.结果 体外循环（CPB）时间87～162 min,主动脉阻断时间73～147 min.2例肝素用量大,超过600 U/kg,补充血浆及加用低分子肝素后ACT＞480 s,术后均顺利脱离CPB;2例死于严重低心排.其余患者均痊愈出院.结论 适当的手术时机是治疗重症感染性心内膜炎的关键.重症感染性心内膜炎患者全身炎症反应（SIRS）强烈,易出现肝素耐药、灌注压低等,采取大容量平衡超滤可明显减轻全身炎症反应综合征,有利于术后恢复.敏感抗生素的正确使用是治疗成功的必要条件.Objective To summarize the experience of treatment of severe infective endocarditis （IE）. Methods From October 2008 to April 2015, 15 patients with severe infective endocarditis were treated surgically in the Aerospace Center Hospital. Preoperative conventional antibiotic treatment for 2 to 4 weeks, were in the gen- eral superficial low temperature （28℃-32℃ ） underwent valve replacement, myocardial protection with 4：1 or HTK solution, using continuous large volume balance Filtration （4000-6000 ml）. Results CPB time ranged from 87-162 min and aortic clamping time from 73-147 min. The dosage of heparin was higher 600 U/kg in 2 cases, after adopting danaparoid and plasma ACT〉480 s. All cases weaned CPB successfully. 2 cases died postoperatively due to refractory low cardiac output syndrome, the others recovered completely. Conclusion The appropriate oper- ative timing is the key to the treatment of severe infective endocarditis. Such patients systemic inflammatory re- sponse（SIRS） strong, prone to heparin resistance, perfusion pressure, etc., to take large-capacity balanced ultra- filtration can significantly reduce the systemic inflammatory response syndrome, is conducive to postoperative re- covery. The correct use of sensitive antibiotics is a necessary condition for successful treatment.

关 键 词：感染性心内膜炎 外科治疗 体外循环 全身炎症反应综合征 

分 类 号：R654.2[医药卫生—外科学]