上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (4): 470-.doi: 10.3969/j.issn.1674-8115.2011.04.020

• 论著（临床研究） • 上一篇    下一篇

右心感染性心内膜炎的围术期处理

周黎瑾, 毛建强, 虞 敏, 袁忠祥, 肖明第   

  1. 上海交通大学附属第一人民医院心血管外科, 上海 200080
  • 出版日期:2011-04-28 发布日期:2011-04-28
  • 通讯作者: 毛建强, 电子信箱: jianqiang.mao@gmail.com。
  • 作者简介:周黎瑾（1975—）, 女, 主治医师, 硕士；电子信箱: renmingdazhong@vip.sina.com。

Perioperative management of right-sided infective endocarditis

ZHOU Li-jin, MAO Jian-qiang, YU Min, YUAN Zhong-xiang, XIAO Ming-di   

  1. Department of Cardiovascular Surgery, The First People's Hospital, Shanghai Jiaotong University, Shanghai 200080, China
  • Online:2011-04-28 Published:2011-04-28

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摘要：

目的 总结右心感染性心内膜炎的围术期处理经验。方法 回顾性分析接受手术治疗的16例右心感染性心内膜炎患者的临床资料。术前所有患者均进行血培养和药物敏感试验，经胸超声心动图检查均发现右心赘生物。所有患者于体外循环下行感染灶和赘生物清除，合并先天性心脏病者进行矫治术，瓣膜损毁者进行瓣膜重建或置换，切除的赘生物进行细菌培养和药物敏感试验。结果 术前共进行血培养30次，阳性率26.7%，4例患者血培养阳性，血培养阴性而赘生物细菌培养阳性5例，6例为革兰阳性葡萄球菌感染，对青霉素耐药。2例患者行急诊手术，5例术后出现胸腔积液，1例因发生心室颤动进行心肺复苏，所有患者均治愈出院。结论 右心感染性心内膜炎患者多有基础心脏疾病，致病菌主要为革兰阳性葡萄球菌，经胸超声心动图可明确诊断，手术治疗可取得满意结果。

关键词: 心内膜炎, 抗菌治疗, 手术

Abstract:

Objective To summarize the experience in perioperative management of right-sided infective endocarditis. Methods The clinical data of 16 patients undergoing surgical treatment for right-sided heart infective endocarditis were retrospectively analysed. Blood culture and drug susceptibility tests were performed, and intracardiac vegetations were revealed by transthoracic echocardiography in all patients before surgery. Foci of infection and vegetations were removed by surgery under cardiopulmonary bypass, congenital heart diseases were corrected, damaged valves were reconstructed or replaced, and bacterial culture and drug susceptibility tests of resected vegetations were performed. Results A total of 30 times of blood culture were conducted, and the positive rate was 26.7%. There were positive findings in 4 patients in blood culture. In patients with negative results in blood culture, 5 patients had positive findings in bacterial culture of vegetations. The pathogens were Gram-positive Staphylococci in 6 patients, which were resistant to penicillin. Two patients had emergency surgery. Pleural effusion occurred in 5 patients after surgery, and 1 patient were performed cardiopulmonary resuscitation due to ventricular fibrillation. All patients were cured and discharged. Conclusion Most patients with right-sided infective endocarditis are complicated with basic heart diseases, the main pathogen is Grampositive Staphylococci, transthoracic echocardiography can help to confirm the diagnosis, and surgical treatment may yield favorable outcomes.

Key words: endocarditis, antibiotic therapy, surgical procedure