先天性心脏病合并感染性心内膜炎的个体化治疗

目的：探讨先天性心脏病（CHD）合并感染性心内膜炎（IE）的个体化治疗。方法：本组病例共73例,主要表现为发热、贫血、栓塞等;血培养及赘生物培养阳性17例（23.3%）,以草绿色链球菌居多,病原体菌种呈现多样化趋势。超声心动图检查阳性率83.6%（61例）。病灶分布以主动脉瓣病变（33例）,二尖瓣病变（21）例为多。所有患者均经外科手术清除感染病灶及赘生物,并相应纠治瓣膜病变和心脏畸形。其中择期手术54例（74.0%）,急诊手术19例（26.0%）。血培养阳性病例应用大剂量敏感广谱抗生素4～8周。结果：本组无手术死亡,均经手术及抗生素治疗后临床痊愈出院。术后随访心功能改善,仅1例1年后心内膜炎复发。结论：大剂量敏感广谱抗生素治疗与积极的相应外科治疗相结合的个体化处理是治疗先天性心脏病合并感染性心内膜炎的重要手段,对提高存活率、降低病死率有着重要的意义。

Individualized treatment of infective endocarditis in patients with congenital heart diseases

Objective: To investigate individualized treatment of infective endocarditis(IE) in patients with congenital heart disease(CHD).Methods:A total of 73 cases were enrolled in the present study,and their main symptoms were fever,anemia,and embolism;blood culture and vegetation cultivation were positive in 17(23.3%) cases.Positive rate of echocardiography was 83.6%(61 cases).Infective focus mainly distributed on aortic valve lesion(33 cases),mitral lesion(21 cases).Infective focus and vegetations were cleaned and valve lesions and cardiac abnormalities were corrected by operation in all patients,including 54(74.0%) cases of selective operation and 19(26.0%) cases of emergency operation.Among cases with positive blood culture,the most common pathogen was viridans streptococcus and species of pathogen were diverse;high dose of sensitive combine antibiotics for 4~8 weeks were applied.Results:There was no operative death and all cases recovered and discharged after operation and treatment with antibiotics.During follow-up,cardiac function improved,only one case recurred endocarditis after one year.Conclusion: Individualized treatment with sensitive broad-spectrum antibiotics combined corresponding operation plays an important role in patients with congenital heart disease complicated infective endocarditis,it may increase survival rate and reduce mortality rate.