感染性心内膜炎的临床诊断与外科治疗

目的：总结58例感染性心内膜炎的临床诊断和外科治疗经验。方法：回顾分析2001年12月至2010年2月我院收治的58例感染性心内膜炎行心脏手术的临床资料。其中男42例,女16例;年龄18-68岁,平均年龄38.5岁,术前血培养58例,阳性27例（44.1%）,其中链球菌15例,葡萄球菌7例,其它细菌5例.超声心动图提示心内膜赘生物或瓣膜穿孔48例,其中累及二尖瓣17例,主动脉瓣11例,二尖瓣主动脉瓣同时受累11例,三尖瓣7例,肺动脉瓣2例。合并原发心脏疾病40例,其中先天性心脏病12例,瓣膜病28例。对58例患者全程采用大剂量敏感抗生素治疗。择期手术44例,急症手术14例。手术中清除所有感染灶,同期矫治心内畸形18例,行心脏瓣膜置换术31例,三尖瓣成形术10例。结果：术后早期死亡2例。随访48例（89%,48/58）,随访4-80个月,无心内膜炎复发,心功能恢复至Ⅰ级40例,Ⅱ级16例,Ⅲ级2例。结论：早期诊断,掌握适当的手术时机,果断采取急诊或亚急诊手术,联合内科治疗和外科手术,可取得良好的治疗效果。

Surgical Treatment and Diagnosis of Infective Endocarditis

Objective：To summarize the clinical diagnostic and therapeutic experiences of infective endocarditis（IE）.Method： Form Dec.2001 to Feb.2010,58 patients underwent heart operation.There were 42 male and 16 femal patients,with an average of 38.5 years old.Blood culture was positive in 27 cases（44.1%）,Streptococcus was found in 15 cases,Staphylococcus in 7 cases and other bacteria in 7 cases.Ultrasonic cardiography（UCG） revealed vegetations or valve perforayion in 48 cases,including 11 aortic valves,17 mitral valves and 11 double valves.40 cases had pirmary cardiac diseases,including 12 cases of congential heart anomalies,28 cases valves fo heart diseases.High dose of sensitive antibiotics were utilized all through the treatment in all patients.There were 44 cases selective surgeries and 14 emergent ones.Infected tissues were debrided radically,intracardiac malformation was coorcted in 18 cases,valve replacement was performed in 31 cases,tricuspid plasty in 10 cases.Result： There were 2 patients of early-death.48 patients（89%,48/58） were followed-up for 4-80 months with no-recurrence.Post-operative cardiac function（NYHA）：class Ⅰ in 40 cases,class Ⅱ in 16 cases,class Ⅲ in 2 cases.Conclusion： Early diagnosis,optimal surgical timing,combined internal medicine and surgical treament provide good therapeutic effect for patients with IE.