动脉导管未闭合并感染性心内膜炎的介入治疗

目的 探讨先天性心脏病合并感染性心内膜炎的治疗措施.方法 对近年来先心病合并感染性心内膜炎的治疗措施进行了文献复习,并报道了1例动脉导管未闭合并心内膜炎患者早期采用Amplatzer导管封堵术的治疗过程.结果 革兰阳性球菌仍是大于2岁儿童的主要致病菌,未发现耐青霉素的链球菌菌株,各种金黄色葡萄球菌对万古霉素敏感.大剂量青霉素或与氨基糖苷类联合仍然是抗感染治疗的首选措施;尽早外科开胸纠正心脏结构畸形、清除瓣膜赘生物或病灶是减少死亡率的关键措施.动脉导管未闭合并心内膜炎患者超声无赘生物,在充分的抗生素治疗的基础上,适时地采用介入治疗方法亦能达到对某些病人治愈的目的.结论 足量敏感的抗生素、早期外科手术是治愈心内膜炎的关键措施,介入治疗可能也是有效的治疗手段之一.

Interventional therapy for infective endocarditis and patent ductus arteriosus

Objective To explore the diagnostic and therapeutic methods of infective endocarditis.Methods The literature data in recent years of the diagnosis and treatment for infective endocarditis were reviewed.The therapeutic experience of Amplatzer procedure in 1 case of infective endocarditis associated with patent ductus arteriosus was analyzed.Results The predominant pathogenic bacteria were Gram-positive cocci in over 2-year-old patients.Penicillin-resistant streptococcus was not found.All kinds of staphylococcus aureus were sensitive to vancomycin.The antibiotic preference was a large dose of penicillin or penicillin combined with aminoglycosides.Early surgical treatment,which corrected the abnormality of heart structure and cleared vegetations or infective focus,was a key measure for the decrease of mortality.In our report,this patient with infective endocarditis associated with patent ductus arteriosus had no visible vegetation in ultrasound examination,and underwent Amplatzer intervention therapy after application of norvancomycin.A good clinical result was obtained in the patient.Conclusion A key therapy is a large dose of sensitive antibiotics and surgery as early as possible.The interventional therapy may be one of effective tools.