感染性心内膜炎的临床诊断与外科治疗

目的 总结感染性心内膜炎（infective endocarditis，IE）的临床诊断和外科治疗经验。方法回顾分析2001年1月至2007年74接受手术治疗的感染性心内膜炎46例，其中合并心脏畸形31例。术前血培养阳性27例（58．70％），超声心动图提示有赘生物、瓣膜穿孔或腱索断裂40例。所有病例全程采用大剂量抗生素治疗。择期手术15例，急诊手术31例。外科手术清除感染病灶，同期纠治心脏畸形。结果手术后死亡1例（2．17％）。随访45例（97．82％），随访时间5-48mo，心功能均恢复Ⅰ-Ⅱ级，未发现有感染性心内膜炎复发病例。结论对不明原因长期发热病人应想到IE的可能，血培养和超声心动图检查有助于IE的诊断。感染性心内膜炎早期诊断、适时手术和内、外科联合治疗是治疗成功的关键。

Surgical Treatment and Clinical Diagnosis of Infective Endocarditis （IE）

Objective To summarize the clinical diagnostic and therapeutic experiences of infective endocarditis. Methods 46 cases with infective endocarditis receiving operation between January 2001 and July 2007 were analyzed retrospectively.31 cases had intracardiac malformation. Blood culture was positive in 27 cases（58.70%）. Ultrasonic cardiography （UCG） revealed vegetations, valve perforation or ruptured chordae tendineae in 40 cases.High dose of sensitive antibiotics were utilized all through the treatment in all IE patients. There were 15 selective surgeries and 31 emergent ones. While infected tissues were debrided radically, intracardiac malformation was corrected. Results There was 1 patients （2.17%） of death after operation. 45 patients （97.82%） were followed-up for 5-48 months with no-recurrence. Post-operative cardiac function was class Ⅰ to class Ⅱ. Conclusions Blood culture and UCG should always be done to evaluate the possibility of IE while a patient presents with fever of unknown origin. The key to treat infective endocarditis success fully depends on early diagnosis, operation at the right time, and combination of internal and surgical treatment.