感染性心内膜炎的围术期治疗和危险因素分析_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

肖荣冬 , 翁国星 , 谢维泉 , 韩涛 , 陈同

福建医科大学省立临床学院福建省立医院心外科，福州 350001;

Corresponding author：

Keywords：

感染性心内膜炎; 治疗; 危险因素

DOI：

10.7507/1007-4848.20140036

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

目的总结感染性心内膜炎的外科治疗经验，对其围术期危险因素进行分析。方法回顾性分析2006年1月至2012年12月福建省立医院224例感染性心内膜炎患者行外科手术治疗的临床资料，男127例，女97例；年龄1～72（47.7±7.2）岁。均有心脏基础性病变，包括心脏瓣膜病171例（二尖瓣病变99例，主动脉瓣病变30例，双瓣膜病变42例）；先天性心脏病40例（先天性二尖瓣关闭不全14例，主动脉瓣关闭不全5例，动脉导管未闭2例，室间隔缺损10例，法洛氏三联症1例，室间隔缺损合并瓦氏窦瘤脱垂3例，室间隔缺损术后主动脉窦脱垂伴主动脉瓣关闭不全4例，先天性主动脉瓣畸形合并动脉导管未闭1例）；3例梅毒性二尖瓣主动脉瓣病变；8例亚急性细菌性心内膜炎（SBE）行主动脉瓣置换术后瓣周漏再发SBE；2例主动脉瓣病变合并动脉导管未闭。分析术后并发症及死亡率，探讨SBE患者的高危因素及治疗方法。结果术中探查赘生物192例，全部送培养，阳性100例，检出率52.08%，其中以金黄色葡萄球菌、表皮葡萄球菌、草绿色链球菌为多见。手术近期死亡10例，死亡率4.46%，主要并发症有低心排血量综合征、肾功能衰竭、术后严重感染、出血、肝功能损害等。结论感染性心内膜炎内科难以控制者应尽早手术治疗。术前心功能低下、严重的耐药性金黄色葡萄球菌感染、心瓣膜置换术后再发感染及术前营养状况不良是感染性心内膜炎治疗的高危因素。

Citation： 肖荣冬, 翁国星, 谢维泉, 韩涛, 陈同. 感染性心内膜炎的围术期治疗和危险因素分析. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(1): 128-131. doi: 10.7507/1007-4848.20140036 Copy

1.	肖荣冬, 翁国星, 韩涛, 等.81例感染性心内膜炎的病原学分析.中国医药, 2006, 1 (1):7-8.
2.	Nakatani S, Mitsutake K, Hozumi T, et al.Current characteristics of infective endocarditis in Japan:an analysis of 848 cases in 2000 and 2001.Circ J, 2003, 67 (11):901-905.
3.	To k, Miyake N, Nagasaki Y, et al.Successful combination therapy with vacomycin and arbekacin against infective endocarditis caused by MRSA.Jpn J Antibiot, 2011, 64 (3):389-394.
4.	Baureschmitt R, Jakob HG, Bahl CF, et al.Operation of infective endocarditis:Results after implantation of mechanical values.Ann Thorac Surg, 1998, 65(5):359-364.
5.	McGiffin DC, Galbraith AJ, Mclachlan GJ, et al.Aortic valve infection.J Thorc Cardiovasc Surg, 1992, 104(4):511-520.
6.	Renzulli A, Carozza A, Romano G, et al.Recurrent infective endocarditis:a multivariate analysis of 21 years of experience.Ann Thorac Surg, 2001, 72 (1):39-43.
7.	Staton WB, Desanctis RW, Weinberg AN, et al.Cardiac surgery in bacterial endocarditis.Circulation, 1968, 38(3):514-523.
8.	Eishi K, Kawazoe K, Kuriyama Y, et al, Surgical lnanagement of infective endocarditis.Associated with cerebral complications.J Thorac Cardiovasc Surg, 1995, 110(15):1745-1755.
9.	Piper C, Wiemer M, Schulte M, et al.Strokeis not a contraindication for urgent valve replacement in accite infective endocarditis.J Heart Valve Dis, 2001, 10(6):703-711.
10.	刘沙, 连锋, 胡振雷, 等.感染性心内膜炎的外科治疗.中国胸心血管外科临床杂志, 2010, 17(6):518-519.
11.	王波, 阎德文, 肖德辉, 等.感染性心内膜炎的诊断与治疗.中国胸心血管外科临床杂志, 2010, 17(1):220-223.
12.	Juan G, Jesus R, Francisco J, et al.Prognostic factors in left-sided endocarditis:results from the andalusian multicenter cohort.BMC Inf Dis, 2010, 10(1):17.
13.	Rehm S, Campion M, Katz DE, et al.Community-based outpatient parenteral antimicrobial therapy (CoPAT) for Staphylococcus aureus bacteraemia with or without infective endocarditis:analysis of the randomized trial comparing daptomycin with standard therapy.J Antimicrob Chemother, 2009, 63 (5):1034-1042.
14.	Romano G, Carozza A, Della Corte A, et al.Native versus primary prosthetic valve endocarditis:comparison of clinical features and long-term outcome in 353 patients.J Heart Valve Dis, 2004, 13 (2):200-208.
15.	Grünenfelder J, Akins CW, Hilgenberg AD, et al.Long-term results and determinants of mortality after surgery for native and prosthetic valve endocarditis.J Heart Valve Dis, 2001, 10 (6):694-702.
16.	Tamura K, Arai H, Yoshizaki T, et al.Long-term outcome of active infective endocarditis with renal insufficiacy in cardiac surgery.Ann Thorac Cardiovasc Surg, 2012, 18 (3):216-221.
17.	Leone S, Ravasio V, Durante-Mangoni E.Epidemiology, characteristics and outcome of infective endocarditis in Italy:the Italian study on endocarditis.Infection, 2012, 40 (5):527-535.

1. 肖荣冬, 翁国星, 韩涛, 等.81例感染性心内膜炎的病原学分析.中国医药, 2006, 1 (1):7-8.
2. Nakatani S, Mitsutake K, Hozumi T, et al.Current characteristics of infective endocarditis in Japan:an analysis of 848 cases in 2000 and 2001.Circ J, 2003, 67 (11):901-905.
3. To k, Miyake N, Nagasaki Y, et al.Successful combination therapy with vacomycin and arbekacin against infective endocarditis caused by MRSA.Jpn J Antibiot, 2011, 64 (3):389-394.
4. Baureschmitt R, Jakob HG, Bahl CF, et al.Operation of infective endocarditis:Results after implantation of mechanical values.Ann Thorac Surg, 1998, 65(5):359-364.
5. McGiffin DC, Galbraith AJ, Mclachlan GJ, et al.Aortic valve infection.J Thorc Cardiovasc Surg, 1992, 104(4):511-520.
6. Renzulli A, Carozza A, Romano G, et al.Recurrent infective endocarditis:a multivariate analysis of 21 years of experience.Ann Thorac Surg, 2001, 72 (1):39-43.
7. Staton WB, Desanctis RW, Weinberg AN, et al.Cardiac surgery in bacterial endocarditis.Circulation, 1968, 38(3):514-523.
8. Eishi K, Kawazoe K, Kuriyama Y, et al, Surgical lnanagement of infective endocarditis.Associated with cerebral complications.J Thorac Cardiovasc Surg, 1995, 110(15):1745-1755.
9. Piper C, Wiemer M, Schulte M, et al.Strokeis not a contraindication for urgent valve replacement in accite infective endocarditis.J Heart Valve Dis, 2001, 10(6):703-711.
10. 刘沙, 连锋, 胡振雷, 等.感染性心内膜炎的外科治疗.中国胸心血管外科临床杂志, 2010, 17(6):518-519.
11. 王波, 阎德文, 肖德辉, 等.感染性心内膜炎的诊断与治疗.中国胸心血管外科临床杂志, 2010, 17(1):220-223.
12. Juan G, Jesus R, Francisco J, et al.Prognostic factors in left-sided endocarditis:results from the andalusian multicenter cohort.BMC Inf Dis, 2010, 10(1):17.
13. Rehm S, Campion M, Katz DE, et al.Community-based outpatient parenteral antimicrobial therapy (CoPAT) for Staphylococcus aureus bacteraemia with or without infective endocarditis:analysis of the randomized trial comparing daptomycin with standard therapy.J Antimicrob Chemother, 2009, 63 (5):1034-1042.
14. Romano G, Carozza A, Della Corte A, et al.Native versus primary prosthetic valve endocarditis:comparison of clinical features and long-term outcome in 353 patients.J Heart Valve Dis, 2004, 13 (2):200-208.
15. Grünenfelder J, Akins CW, Hilgenberg AD, et al.Long-term results and determinants of mortality after surgery for native and prosthetic valve endocarditis.J Heart Valve Dis, 2001, 10 (6):694-702.
16. Tamura K, Arai H, Yoshizaki T, et al.Long-term outcome of active infective endocarditis with renal insufficiacy in cardiac surgery.Ann Thorac Cardiovasc Surg, 2012, 18 (3):216-221.
17. Leone S, Ravasio V, Durante-Mangoni E.Epidemiology, characteristics and outcome of infective endocarditis in Italy:the Italian study on endocarditis.Infection, 2012, 40 (5):527-535.

Previous Article
主动脉弓右降畸形压迫食管误诊为食管平滑肌瘤一例
Next Article
原发性腹壁肿瘤切除术后巨大腹壁缺损修复2例报道

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

感染性心内膜炎的围术期治疗和危险因素分析

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content