摘要
目的探讨围术期细菌培养为阴性的主动脉瓣感染性心内膜炎诊疗方法。方法回顾性分析2013年1月至2018年1月73例在本单位行主动脉瓣感染性心内膜炎手术的患者资料,其中男59例、女14例,年龄14~71(39.2±14.8)岁,患者围术期细菌培养均为阴性。结果共67例(91.8%)患者行主动脉瓣置换术,2例(2.7%)在住院期间进行了第二次手术,12例(16.4%)患者同期行二尖瓣成形术。住院期间死亡8例(11.0%),11例术后出现低心排血量,4例术后出现房室传导阻滞,1例行永久起搏器植入。1年及5年生存率分别为92.3%±2.3%和84.5%±4.5%。结论细菌培养阴性结果的主动脉瓣感染性心内膜炎在诊断及药物治疗方面都存在困难,而许多患者由于术前广谱抗生素的应用而处于相对平稳阶段,因此出现细菌培养阴性的结果。这类患者均应在机体未出现失代偿前进行手术治疗,其住院死亡与既往有心脏手术病史相关,手术后远期生存率较好。
Objective To discuss the diagnosis and treatment of culture-negative aortic infective endocarditis.Methods The clinical data of 73 patients with infective endocarditis of the aortic valve whose results of bacteria culture were negative from January 2013 to January 2018 were retrospectively analyzed,including 59 males and 14 females aged14-71(39.2±14.8)years.Results Sixty seven(91.8%)patients received aortic valve replacement,2(2.7%)patients received the second operation in hospital,and 12(16.4%)patients had concomitant mitral valvuloplasty.In-hospital death occurred in 8(11.0%)patients.Postoperatively,11(20.7%)patients had a low cardiac output and 4(11.0%)patients had heart block,and 1 patient required implantation of a permanent pacemaker.The 1-and 5-year survival rates were92.3%±2.3%and 84.5%±4.5%,respectively.Conclusion There are difficulties in the diagnosis and treatment of culturenegative infective endocarditis.Most of the affected patients are in a healed status,which could be a cause of negative culture results.In-hospital mortality in the patients is associated with a history of previous cardiac surgery,whereas the long-term survival rate is good for the patients after surgery.
作者
董小超
杨金保
段维勋
刘大伟
刘洋
俞世强
DONG Xiaochao;YANG Jinbao;DUAN Weixun;LIU Dawei;LIU Yang;YU Shiqiang(Department of Cardiovascular Surgery,Xijing Hospital,The Fourth Military Medical University,Xi'an,710032,P.R.China)
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2020年第7期749-753,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
国家重点研发计划项目(2016YFC1301900)
陕西省自然科学基础研究计划(2016JM8083)。
关键词
感染性心内膜炎
培养阴性
主动脉瓣
治疗
Infective endocarditis
culture-negative
aortic valve
treatment
