85例感染性心内膜炎的临床诊断与外科治疗

【摘要】 目的 总结感染性心内膜炎(IE)的临床诊断、外科手术和围手术期处理的经验。方法 回顾性分析2004年9月至2012年12月在我院接受手术治疗的85例IE患者的临床资料。其中男52例,女33例,年龄15~71岁,平均年龄35±16.2岁。85例患者中,12例患者接受了急诊手术治疗;71例患者术前进行了血培养检查,其中阳性18例(阳性率25.4%);超声心动图检查发现赘生物患者73例。所有患者均经外科手术清除感染病灶,纠治瓣膜病变及心脏畸形。结果 全组无手术死亡,均痊愈出院。随防72例,随防时间2~95月,平均53.3±26月,1例因自行停服抗凝药导致机械瓣栓塞死于出院后半年。其余71例术后感染性心内膜炎均未复发。术后心功能恢复至I级61例,心功能恢复至II级24例。结论 早期诊断、适时手术,彻底清除感染病灶,和正确使用抗生素是治疗感染心内膜的重要措施。

Clinical diagnosis and surgical treatment of infective endocarditis in 85 cases

Objective To summarize the experience of clinical diagnosis,.surgical operation and perioperative treatment of infective endocarditis（IE）..Methods From September 2004 to December 2012,.85 IE patients underwent heart operations in our hospital..There were 52 male and 33 female patients,.with an average age of 35 ±16.2 years old..Twelve patients undevwent emergency operation..Seventy-one patients received preoperative blood culture and the positive rate was 28.1%（20 /71）..Ultrasound echocardiography found vegetation in 73 patients..All patients received surgical removal of infected lesions,.correction of valvular lesions and malformation of heart..Results All patients were recovered and discharged..No patient died of surgical procedure..Follow-up was performed in 72 patients and the duration was from 2-95.（53.3 ±26）.months..No recurrence was found in 71 cases..The cardiac function status was NYHA I in 61 cases and NYHA II in 24 cases..Conclusion Early cliagnosis,controlled optimal surgiealtiming,complete clearance of infective foci and corrected use of antibiotics are an important measure for the treatment of infective endocarditis.