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find Keyword "感染性心内膜炎" 46 results
  • 感染性心内膜炎临床护理

    【摘要】感染性心内膜炎(infective endoearditis,IE)是一种严重威胁人类健康及生命的疾病,可导致心力衰竭、栓塞及心律失常等并发症,有较高的死亡率。对IE患者进行全面细致的护理及指导,强化健康教育,可减少相关并发症的发生,缩短住院时间,降低死亡率,从而改善患者的预后。

    Release date:2016-08-26 02:21 Export PDF Favorites Scan
  • 先天性心脏病合并肺动脉瓣感染性心内膜炎的外科治疗

    目的 探讨先天性心脏病合并肺动脉瓣感染性心内膜炎的外科治疗方法和效果。 方法 2009年1月至2012年1月第二军医大学长海医院收治先天性心脏病合并肺动脉瓣感染性心内膜炎患者6例,男1例,女5例;年龄8~41 (24.8±11.8)岁。动脉导管未闭(PDA)4例,PDA合并先天性主动脉瓣狭窄1例,室间隔缺损(VSD)合并三尖瓣反流1例。3例行PDA结扎+肺动脉内赘生物清除术,1例行PDA结扎+肺动脉瓣赘生物切除术,1例行PDA结扎+肺动脉瓣赘生物切除术+主动脉瓣置换术(AVR,置换19 mm CarboMetics环上机械主动脉瓣),1例肺动脉瓣膜破坏严重,行VSD修补+右心室流出道赘生物清除+右心室流出道拓宽+三尖瓣成形术+肺动脉生物瓣置换术(置换27 mm HancockⅡ型生物瓣)。 结果 6例患者术后均恢复良好,无围术期死亡和心内膜炎复发。所有患者复查超声心动图提示,未见赘生物、残余漏、瓣周漏等并发症。术后随访6个月~3年中,患者临床症状完全消失,均无明显不适。术后心功能恢复至Ⅰ级5例,Ⅱ级1例。 结论 对于先天性心脏病合并肺动脉瓣感染性心内膜炎患者,正确把握手术时机,积极行外科手术治疗是最有效的治疗方法。

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • 右侧开胸小切口清除多次心脏术后感染性心内膜炎赘生物一例

    Release date:2016-08-30 05:46 Export PDF Favorites Scan
  • 感染性心内膜炎104例的临床分析

    目的 探索感染性心内膜炎的临床特点及治疗结果,以提高其临床疗效。 方法 回顾性分析2008年1月至2009年12月北京阜外心血管病医院104例感染性心内膜炎患者的临床资料,其中男64例、女40例,平均年龄40.8岁,血培养阳性47例(45.2%)。超声心动图检查提示:90例(86.5%)心脏瓣膜或流出道有赘生物,赘生物位于主动脉瓣36例,二尖瓣32例,三尖瓣11例,右心室流出道3例,多个瓣膜6例。据血培养结果行药物或外科手术治疗,术前及术后应用敏感抗生素治疗。 结果 全组33例行内科药物治疗,病死率为33.3% (11/33);72例行外科手术清除赘生物及进行心脏基础病变治疗,病死率为4.1% (3/72)。死亡原因1例为低心排血量,1例感染,1例脑梗塞。赘生物培养均为阴性。体外循环时间(117.5±63.3) min,主动脉阻断时间(82.7±44.8) min。总的中位住院时间30.9 d,术后住院时间13 (6~41) d。术后有3例感染再发,2例因为瓣周漏引起感染再发,1例行瓣膜成形术后感染再发。 结论 基础心脏病仍是感染性心内膜炎常见病因。早期、有效、规律的抗生素治疗仍是治疗基础,及时的外科治疗可降低病死率。

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • Clinical Diagnosis and Surgical Therapy for Blood Culture-Negative Infective Endocarditis

    Objective To investigate clinical diagnosis,timing of surgery and perioperative therapeutic strategies for blood culture-negative infective endocarditis (IE). Methods Clinical data of 240 IE patients who were admitted tWuhan Asia Heart Hospital between July 2008 and July 2012 were retrospectively analyzed. According to their blood cultureresults,all the patients were divided into blood culture-negative group and blood culture-positive group. In the blood culture-negative group,there were 158 patients including 88 male and 70 female patients with their age of 51.3±10.1 years. In the blood culture-positive group,there were 82 patients including 45 male and 37 female patients with their age of 48.9±9.8 years. All the patients underwent surgical treatment,and the surgical procedures included complete vegetations excision,debridement of infected valves,removal of necrotic tissue around the annulus,and concomitant heart valve replacement or intracardiac repair. Postoperatively,all the patients received routine monitoring in ICU,cardiac glycosides,diuretics,other symptomatic treatment and adequate dosages of antibiotics for 4-6 weeks. Results Four patients died postoperatively in this study including 1 patient for low cardiac output syndrome and 3 patients for multiple organ dysfunction syndrome,1 patient in the blood culture-positive group and 3 patients in the blood culture-negative group respectively. There was no statistical difference in surgical mortality between the 2 groups (χ2=0.15,P=0.70). All the other patients were discharged successfully and followed up for 6 to 36 months with the median follow-up time of 22 months. During follow-up, 2 patients died including 1 patient for cerebral infarction 2 years after surgery and another patient for cerebral hemorrhage 3 yearsafter surgery. Conclusion Patients with blood culture-negative IE should receive adequate dosage and duration of broad-spectrum antibiotics to control the infection rapidly, and aggressive surgical therapy to decrease in-hospital mortality and improve their quality of life and prognosis.

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • 不同基础心脏病感染性心内膜炎的外科治疗

    目的 总结不同基础心脏病合并感染性心内膜炎的临床特点、手术方法以及治疗效果。 方法 回顾性分析新疆医科大学第一附属医院1995 年5 月至2008 年8 月接受手术治疗92 例感染性心内膜炎患者的临床资料,根据其基础病变的不同,将92 例患者分为先天性心脏病组(先心病组,n=37)和风湿性心脏瓣膜病组(瓣膜病组,n=55),比较、分析两组患者术前、术中和术后的临床指标。 结果 先心病组与瓣膜病组患者年龄(t =-4.484,P=0.000)、中性粒细胞百分比(t =-2.594,P=0.011)、血红蛋白(t = -2.471, P= 0.015)、左心室舒张期末内径(t = -3.622,P=0.000)、主动脉阻断时间(t=23.469, P=0.001)、体外循环时间(t =21.549, P=0.000)差异有统计学意义;而其余临床指标差异均无统计学意义(P > 0.05)。 结论 先天性心脏病与风湿性心脏瓣膜病合并感染性心内膜炎的临床特点相似,手术治疗侧重点不同,但治疗效果无明显差异。

    Release date:2016-08-30 05:48 Export PDF Favorites Scan
  • 120例感染性心内膜炎的外科治疗

    目的总结 120例感染性心内膜炎( IE)的围术期处理经验,探讨手术时机和方法。方法回顾性分析华中科技大学附属协和医院 2006年 1月至 2011年 4月 120例感染性心内膜炎患者接受手术治疗的临床资料,男 75例,女 45例;年龄 4~ 73(44±3)岁。以发热为主就诊 36例,术前心功能不全 54例,脑栓塞 10例,血培养阳性 20例,超声心动图证实心内有赘生物形成 111例。所有患者均在体外循环下进行赘生物清除、心瓣膜置换术及原发心脏病矫正手术。术后继续使用抗生素治疗 4~ 6周。结果全组患者术后住院时间 14~ 60(20±6)d,无手术死亡。全组术后死亡 5例;生存出院 115例,出院患者随访 3个月~ 4年,均恢复良好。术后发生并发症 20例,再次手术患者 2例。结论感染性心内膜炎应做到早发现、早诊断、早治疗,并掌握好手术时机和原则,恰当的围手术期处理,可取得良好的效果。

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • Surgical Treatment for Hypertrophic Obstructive Cardiomyopathy Complicated by Infective Endocarditis

    Abstract:?Objective?To analyze surgical procedures and clinical outcomes for patients with hypertrophic obstructive cardiomyopathy (HOCM) complicated by infective endocarditis.?Methods?We retrospectively analyzed clinical data of 7 patients with HOCM complicated by infective endocarditis who underwent modified Morrow procedure,removal of intracardiac vegetation,and valve replacement in Fu Wai Hospital from Sep. 2006 to Feb. 2012. There were 5 male patients and 2 female patients with their mean age of 39.80±13.60 years(ranging 21-55). Postoperative clinical outcomes were observed. Preoperative and postoperative left ventricular outflow tract (LVOT) gradients, left atrium (LA) diameter,left ventricular ejection fraction (LVEF) and heart function were compared.?Results?There was no in-hospital death and perioperative survival rate was 100% in this group. Bacteria vegetations were multiply detected on the mitral valve leaflet (7 cases), aortic valve leaflet (4 cases) and ventricular septum (1 case) with their diameter of 2-19 mm. Blood culture showed Staphylococcus aureus (3 cases),Squirrel aureus (1 case) . Postoperatively, first-degree atrioventricular block occurred in 2 patients, complete left bundle branch block in 1 patient, left anterior division block in 2 patients, and all these complications were not treated. Postoperative LVOT gradient and LA diameter were significantly lower than preoperative values (P<0.05), and cardiac function was significantly improved in these patients. All the patients underwent transthoracic echocardiography at a mean follow-up of 13.00±17.19 (1-49) months in outpatient service. The clinical symptoms of all these patients were diminished or significantly ameliorated and their quality of life was considerably improved. All the patients had NYHA classⅠorⅡ without any reintervention or death during follow-up.?Conclusion?Modified Morrow procedure and valve replacement is a good surgical strategy for patients with HOCM complicated by infective endocarditis with satisfactory early and mid-term clinical outcomes.

    Release date:2016-08-30 05:51 Export PDF Favorites Scan
  • 心源性脑栓塞患者的心瓣膜置换术

    摘要: 目的 [HTSS]探讨心源性脑栓塞患者行心瓣膜置换术的手术时机、疗效,总结围手术期处理经验。 方法 回顾性分析1999年6月至2008年10月42例心源性脑栓塞患者接受心瓣膜置换术的临床资料,男25例,女17例;年龄28~64岁,平均年龄45.5岁;病程0.5~30.0年。风湿性心脏病31 例,感染性心内膜炎11 例;行二尖瓣置换术27例,主动脉瓣置换术11例,二尖瓣和主动脉瓣联合瓣膜置换术4例;同期行三尖瓣成形术18例,左心房血栓清除术22例。 结果 术后早期(30 d内)死亡4例,手术死亡率9.52%;其中死于鱼精蛋白过敏、严重肺部感染、急性肾功能衰竭、脑出血和广泛脑栓塞各1例;其余患者均顺利出院,术后平均住院时间为12.5 d。随访35例,随访时间2~112个月,随访期间死亡5例,其中1例术后1个月余因头部外伤致颅内出血死亡,1例3年后死于脑出血,1例5年后死于肺癌, 2例6年后死于心力衰竭;其余患者生存状况良好。失访3例。 结论 心源性脑栓塞患者行心瓣膜置换术效果良好,应根据心瓣膜病变程度、心功能状况以及脑栓塞的程度决定手术时机。脑栓塞后有以下情况者可尽早手术治疗:(1)急性心力衰竭、心功能Ⅳ级,经内科保守治疗效果不佳;(2)梗塞灶小,偏瘫轻,或偏瘫后恢复快;(3)伴左心房血栓或心瓣膜赘生物,短期内可能再次栓塞者。加强围手术期处理是手术成功的重要因素。

    Release date:2016-08-30 06:02 Export PDF Favorites Scan
  • 感染性心内膜炎的外科治疗

    摘要: 目的 总结自身瓣膜感染性心内膜炎的外科治疗经验。 方法 2000年1月至2008年6月上海交通大学医学院附属仁济医院收治感染性心内膜炎患者49例,男27例,女22例;年龄14~74岁,平均年龄44.2岁。基础疾病:先天性心脏病12例,包括室间隔缺损、右心室流出道狭窄、主动脉窦瘤和动脉导管未闭等;后天性心瓣膜病34例,包括风湿性二尖瓣病变、主动脉瓣病变和老年性心瓣膜退行性变等。不合并基础心脏疾病3例。所有患者均在低温体外循环下施行先天性心脏病矫治术和心瓣膜置换术;术中尽可能清除赘生物,对受侵犯的组织采用碘伏溶液多次擦洗,再用生理盐水彻底冲洗。术后给予抗生素治疗4~6周。 结果 围术期死亡2例(4.08%),1例因心力衰竭死亡,另1例因严重肺部感染死亡。术后2例患者持续发热,继续给予抗生素治疗2周后,体温渐趋平稳。随访35例(71.43%),随访时间4个月至6年,失访12例。1例室间隔缺损、三尖瓣赘生物患者手术后1个月再次发热,再次入院接受抗生素治疗后治愈。3例发生抗凝治疗并发症,出现牙龈或结膜出血、皮肤瘀斑、血尿、消化道出血,暂停抗凝治疗后好转。随访期间未见感染性心内膜炎复发。 结论 早期诊断、正确把握手术时机,药物与手术相结合是成功治疗感染性心内膜炎的关键。

    Release date:2016-08-30 06:03 Export PDF Favorites Scan
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