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感染性心内膜炎急诊手术经验总结

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目的 总结急诊手术治疗感染性心内膜炎(IE)的临床经验.方法 回顾性分析 2019 年 1 月至2022 年 8 月在苏州大学附属第一医院心脏大血管外科诊治的 76 例IE患者的临床资料,总结并分享急诊手术治疗IE的经验.结果 76 例IE患者中男性 55 例(72.4%),女性 21 例(27.6%),男性和女性比例为 2.6∶1;年龄 17~76 岁,平均(52.1±15.6)岁;血培养阳性率 25.0%(19 例);治愈 57 例(75.0%),自动出院 8 例(10.5%),好转 9 例(11.8%),术前死亡 2 例(2.6%).患者行二尖瓣手术 30 例(39.5%),主动脉瓣置换手术 24 例(31.6%),二尖瓣+主动脉瓣手术 12 例(15.7%);合并先天性心脏病 15 例(19.7%),风湿性心脏病 69 例(90.8%);左心系统赘生物 66 例(93.0%),右心系统 4 例(5.6%);行急诊手术 13 例(17.1%),且无死亡病例.结论 IE病死率较高,目前有效的治疗方法仍然是外科手术,但手术时机仍有争议.本研究经过多例急诊手术总结经验,认为只要患者情况允许,尽早手术可提高患者的存活率,改善预后.
Summary of experience in emergency operation of infective endocarditis
Objective To summarize the experience of infectous endocarditis(IE)emergency surgery.Methods A total of 76 patients admitted to the department of cardiovascular surgery of the First Affiliated Hospital of Soochow University from January 2019 to August 2022 were retrospectively analyzed.Summarize and share treatment experience.Results Out of 76 IE patients,55 cases(72.4%)were male and 21 patients(27.6%)were female.The ratio of male to female was 2.6∶1.The age ranged from 17-76 years,with a mean of(52.1±15.6)years.The positive rate of blood culture was 25.0%(19 cases).A total of 57 cases(75.0%)were cured,8 cases(10.5%)were discharged automatically,9 cases(11.8%)were improved,and 2 patients(2.6%)died before operation.There were 30 patients(39.5%)who underwent mitral valve surgery,24 patients(31.6%)who underwent aortic valve surgery,12 patients(15.7%)who underwent mitral and aortic valve surgery;15 patients(19.7%)with congenital heart disease,69 patients(90.8%)with rheumatic heart disease;66 patients(93.0%)with left cardiac system vegetations,4 patients(5.6%)with right cardiac systems vegetations;13 patients(17.1%)who requied emergency surgery,and no death.Conclusions The mortality of IE is high,and the current effective treatment is still surgery,but the timing of surgery is still controversial.This study summarized the experience of several cases of emergency operation and concluded that as long as the patient's condition permits,early operation can improve the survival rate of patients and improve the prognosis.

EndocarditisSymptom and signComplicationPathogenic bacteria

陈磊、余云生、司可、刘坦

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苏州大学附属第一医院心脏大血管外科和苏州大学心血管病研究所,江苏苏州 215006

心内膜炎 症状和体征 并发症 病原菌

江苏省卫生健康委重点项目

ZDA2020017

2024

中国中西医结合急救杂志
中国中西医结合学会

中国中西医结合急救杂志

CSTPCD
影响因子:1.925
ISSN:1008-9691
年,卷(期):2024.31(3)
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