摘要
目的探讨静脉药瘾感染性心内膜炎患者的临床特征、外科治疗方法和效果。方法回顾性分析海南医学院第二附属医院心血管外科2008年1月至2017年12月经手术治疗的24例静脉药瘾感染性心内膜炎患者的临床资料。24例患者发病前均有静脉注射毒品史8个月~10年,平均(5.8±2.1)年;男性19例,女性5例;年龄15~45岁,平均(27.3±6.9)岁。入院后均行超声心动图、3次以上血培养检查,术前开始使用有效抗生素,外科治疗后继续使用抗生素4~6周。结果所有患者均有发热病史,主要临床表现为呼吸道症状21例、心功能不全16例、贫血18例、心脏杂音19例、脑梗塞并脑出血1例、肺脓肿1例、脾大5例、肝炎8例、梅毒1例、肾功能不全4例、戒断症状1例;超声心动图提示受累瓣膜中度及以上返流20例、心脏瓣膜赘生物18例,血培养阳性17例;治疗方法中,二尖瓣置换术4例,二尖瓣置换联合三尖瓣成形术1例,二尖瓣、主动脉瓣置换术1例,二尖瓣成形术1例,主动脉瓣置换术2例,三尖瓣置换术2例,三尖瓣成形术10例,肺动脉瓣成形术2例,肺动脉瓣成形、室间隔缺损修补、卵圆孔未闭修补及右肺脓肿病灶清除1例;术后30 d死亡2例,死亡率为8.3%,主要并发症有支气管胸膜瘘、低心排血量综合征、肺部感染、急性肝肾功能损害、切口感染;出院后随访5年,1例戒毒失败导致感染性心内膜炎复发行两次二尖瓣置换术,1例主动脉瓣机械瓣大量瓣周漏、心衰行二次手术,余患者生存状况良好。结论静脉药瘾感染性心内膜炎患者常合并传染病,右心瓣膜病变多见于左心,使用有效抗生素及积极外科手术是治疗静脉药瘾感染性心内膜炎的有效方法。
Objective To study the clinical characteristics, surgical treatment methods, and result of intravenous-drug-abuse related infective endocarditis. Methods We retrospectively analyzed the clinical information of 24 patients with intravenous-drug-abuse related infective endocarditis treated in Department of Cardiovascular Surgery, Second Hospital Affiliated to Hainan Medical University, from January 2008 to December 2017. All the 24 patients had history of intravenous drug abuse for 8 months to 10 years before the onset of the disease, with an average of(5.8 ± 2.1) years.There were 19 males and 5 females among the 24 patients, who were aged from 15 to 45 years old, with an average of(27.3±6.9) years old. All patients received echocardiography, more than 3 times of blood culture, effective antibiotic administration before operation and continued antibiotic therapy for 4-6 weeks after surgery. Results Clinically all the patients presented fever, with 21 cases of respiratory symptoms, 16 cases of cardiac insufficiency, 18 cases of anemia, 19 cases of cardiac murmurs, 1 case of cerebral infarction with cerebral hemorrhage, 1 case of pulmonary abscess, 5 cases of splenomegaly, 8 cases of hepatitis, 1 case of syphilis, 4 cases of renal inadequacy, and 1 case of drug abstinence symptoms. Echocardiography found moderate and above blood reflux of affected aortic valve in 20 patients, vegetation on the infected valves in 18 patients, and positive blood culture results in 17 patients. As for treatment methods, 4 patients underwent mitral valve replacement and 1 case underwent mitral valve replacement combined with tricuspid valvuloplasty,with 1 case of mitral and aortic valve replacement, 1 case of plastic surgery for mitral valve, 2 cases of aortic valve replacement, 2 cases of tricuspid valve replacement, 10 cases of tricuspid valvuloplasty, 2 cases of pulmonary valvuloplasty, 1 case of pulmonary valve formation, 1 case of ventricular septal defect repair, and 1 case of patent foramen ovale repair and clearance of right lung abscess. There were 2 deaths in 30 days after operation, and the mortality rate was 8.3%.The main complications included bronchopleural fistula, low cardiac output syndrome, pulmonary infection, acute liver and kidney dysfunction, and wound infection. During the 5-year follow-up after discharge, one patient of recurrent infective endocarditis caused by drug rehabilitation failure underwent a second mitral valve replacement, one patient of aortic valve mechanical valve with multiple valve leakage and heart failure underwent a second surgery, and the remaining patients survived in good condition. Conclusion Patients with intravenous-drug-abuse related infective endocarditis are often complicated with infectious diseases, and right heart valve disease is often seen in the left heart. The use of effective antibiotics and active surgery is an effective treatment for intravenous-drug-abuse related infective endocarditis.
作者
陈道虎
何书武
刘辉
葛广全
陈泽伦
CHEN Dao-hu;HEShu-wu;LIU Hui;GE Guang-quan;CHEN Ze-lun(Department of Cardiovascular Surgery,Second Hospital Affiliated to Hainan Medical University,Haikou 570311,Hainan,CHINA;Department of Anatomy,Hainan Medical University,Haikou 571101,Hainan,CHINA)
出处
《海南医学》
CAS
2019年第17期2216-2219,共4页
Hainan Medical Journal
关键词
静脉药瘾
感染性心内膜炎
传染病
抗生素
外科手术
Intravenous drug abuse
Infective endocarditis
Infectious disease
Antibiotics
Surgical treatment
