感染性心内膜炎外科治疗--附21例报告

目的　回顾分析感染性心内膜炎外科治疗经验。方法　对2 1例感染性心内膜炎患者术中彻底清除炎症坏死组织后,作主动脉瓣置换(AVR) 10例、二尖瓣置换(MVR) 7例、MVR 三尖瓣DeVega成形1例、三尖瓣置换(TVR) 1例、三尖瓣瓣膜缺损修复2例;同期室间隔缺损(VSD)修补2例、漏斗胸矫治1例;本组急症手术7例,均为主动脉瓣病变,其中高热不退2例、循环衰竭少尿5例;围手术期均使用足量敏感或广谱抗生素、改善心功能和全身营养支持治疗。结果　全组术后早期死亡2例,1例死于多器官系统衰竭(MOSF)、1例死于脑血管意外,其余19例均痊愈出院。结论　手术可提高感染性心内膜炎治疗成功率。恰当的手术时机、合理的手术方法和正确的围手术期处理,均是外科治疗成功的关键。

Surgical treatment of infectious endocarditis:21 cases report

Objective To review the surgical treatment results of infectious endocarditis (IE). Methods A total of 21 patients with IE was treated surgically. After the infected tissue excision, valve replacement/repair or annuloplasty were performed subsequently, including aortic valve replacement (AVR) (n=10), mitral valve replacement (MVR) (n=7), MVR plus tricuspid De Vega annuloplasty (n=1), tricuspid valve replacement (TVR) (n=1), tricuspid valve repair (n=2), ventricular septal defect (VSD) repair ( n=2), and pectus excavatum correction (n=1). 7 cases with persistent high fever or cardiac failure were treated in emergency surgery. In these patients, the treatment of antibiotic therapy, cardiac function improvement and nutritional support were applied perioperatively. Results 2 cases died early postoperative (the causes of death were MOSF and cerebral vascular accident, respectively), the remainders were recovered and discharged. Conclusion Surgical operation might offer better clinical outcome, while perioperative appreciated operating time, proper surgical technique, and correct management are the highlights for the success of surgical treatment.