感染性心内膜炎外科治疗106例

摘要

Objective To review the clinical experience in the surgical treatment of infective endocarditis,and to summarize the key points of how to elevate therapeutic effect.Methods From Jan 2001 to Dec 2010,106 patients with infective endocarditis who underwent operative therapy were retrospectively analyzed.All patients underwent cardiac operation in conventional hypothermic cardiopulmonary bypass.Vegetations and suspicious infective focus were thoroughly cleaned.Endocardium was swabbed with normal sodium repeatedly and with high concentration antibiotic solution.Combined anomalies were rectified and the affected valves were replaced.Artificial valves were preconditioned with antibiotics before implantation.All patients were treated with full dose of sensitive antibiotics for 6-8 weeks after operation.Results Two patients(1.8％) died perioperatively,1 died of severe pulmonary infection 5 days post operation,and 1 died of multisystem organ failure.Other 104 patients recovered smoothly,95 of whom were followed up for 6 months to 10 years.One patient died,and the other patients recovered with Ⅰ-Ⅱ grade heart function(NYHA).Three patients had anticoagulation related complications.There was no relapse of endocarditis occurred during the period of follow-up.Conclusion Early diagnosis and timely operation on infective endocarditis can achieve satisfactory effect.The thorough sterilization,prosthetic valves precondition and post operative regular antibiotics therapy were the key points of successful surgical treatment.%目的 总结感染性心内膜炎的外科治疗经验.方法 2001年1月至2010年12月,106例感染性心内膜炎患者均在低温体外循环下施行手术,术中彻底清除赘生物和可疑感染灶,大量生理盐水冲洗心腔,浓抗生素溶液反复擦洗;充分纠正心内合并畸形;置换病变累及瓣膜,人工瓣膜缝合前行抗生素预处理.术后足量、敏感抗生素治疗6～8周.结果 围手术期死亡2例(1.8％),分别于术后第5天死于严重肺部感染和第9天死于多脏器功能衰竭,余均治愈出院.95例随访6个月至10年.随访期间无心内膜炎复发.除1例死亡,余者心功能(NYHA)恢复至Ⅰ～Ⅱ级,能正常生活和工作.3例发生抗凝治疗相关并发症.结论 感染性心内膜炎早期诊断和及时手术可取得良好效果,术中无菌、移植物预处理及术后正规抗菌药物治疗是关键.