论文部分内容阅读
目的总结小儿先天性心脏病(先心病)继发感染性心内膜炎(IE)外科治疗的临床经验。方法本院2002年1月-2011年4月收治先心病并IE患儿15例。男7例,女8例;年龄3～12岁;体质量10～27 kg。术前血培养均阳性,其中链球菌7例,葡萄球菌6例,其他细菌2例。超声心动图示心内膜赘生物15例,其中二尖瓣或(和)三尖瓣赘生物13例,补片上赘生物2例,并瓣膜穿孔3例,手术彻底清除感染病灶,重建受损心内结构,同时矫治先心病畸形。手术方式:VSD修补4例,ASD修补2例,ASD/VSD修补+三尖瓣成形术5例,ASD修补+二尖瓣置换术+三尖瓣成形术2例,涤纶补片摘除+VSD修补1例,右心室流出道重建术1例。体外循环(CPB)采用中低温(26～30℃),中高流量80～120 mL.kg-1.min-1灌注。心肌保护方式为使用St.ThomasⅡ冷晶体或4℃冷血液心脏停搏液(血晶体=41)顺行灌注。结果 CPB总时间85～180 min,主动脉阻断时间40～120 min,患儿均顺利脱离CPB,无CPB相关并发症,术后感染治愈。术后重症监护室监护时间1～6 d,住院时间40～60 d。本组2例术中探查发现并右上肺肺段栓塞;3例伤口感染;1例术后出现急性肾功能不全。随访3个月～9 a,1例术后2 a死亡,死亡原因为心力衰竭;余14例患儿无IE复发。结论积极手术干预的理念、准确的手术方式、个体化CPB对患儿恢复至关重要。
Objective To summarize the clinical experience of surgical treatment of secondary infectious endocarditis (IE) in children with congenital heart disease (CHD). Methods From January 2002 to April 2011, 15 cases of children with congenital heart disease and IE were admitted to our hospital. 7 males and 8 females; aged 3 to 12 years old; body weight 10 ~ 27 kg. Preoperative blood culture were positive, including Streptococcus 7 cases, Staphylococcus 6 cases, other bacteria in 2 cases. Echocardiography showed endocardial neoplasms in 15 cases, of which mitral valve or (and) tricuspid valve neoplasm in 13 cases, 2 cases of vegetation on the valve, and 3 cases of valve perforation, surgery to completely clear the infected lesions and reconstruction of damaged Heart structure, at the same time correction of congenital malformations. Surgical methods: VSD repair in 4 cases, ASD repair in 2 cases, ASD / VSD repair + tricuspid plasty in 5 cases, ASD repair + mitral valve replacement + tricuspid plasty in 2 cases, Dacron patch + VSD repair 1 case, right ventricular outflow tract reconstruction in 1 case. Cardiopulmonary bypass (CPB) with low temperature (26 ~ 30 ℃), the high-flow 80 ~ 120 mL.kg-1.min-1 perfusion. Myocardial protection was performed with either St. Thomas II cold crystals or cold blood cardioplegia at 4 ° C (blood crystals = 4 1). Results The total time of CPB was 85-180 min and the time of aortic block was 40-120 min. All patients were successfully separated from CPB without CPB-related complications and the postoperative infection was cured. Postoperative intensive care unit monitoring time 1 ~ 6 d, hospital stay 40 ~ 60 d. The group of 2 cases found intraoperative exploration and upper right lung pulmonary embolism; wound infection in 3 cases; 1 case of acute renal failure. The follow-up ranged from 3 months to 9 years. One case died 2 days after operation. The cause of death was heart failure. The other 14 cases had no recurrence of IE. Conclusion The concept of active surgical intervention, accurate surgical methods, and individualized CPB are essential for the recovery of children.