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[感染性心内膜炎的治疗]

[Treatment of infective endocarditis].

作者信息

Arregle Florent

机构信息

Service de cardiologie, insuff isances cardiaques et valvulopathies, hôpital de La Timone, AP-HM, Marseille, France.

出版信息

Rev Prat. 2024 Jun;74(6):646-652.

Abstract

TREATMENT OF INFECTIVE ENDOCARDITIS. Patients with infective endocarditis (IE) are taken care for by multidisciplinary teams. The treatment consists of antibiotic therapy initiated early, adapted to the responsible germ and prolonged, associated with surgical treatment when there is an indication for surgery. A parenteral antibiotic therapy is initiated in hospital for a period of at least two weeks. Depending on evolution of the patients, outpatient antibiotic treatment may be considered, and oral antibiotics may be proposed in stable patients when IE is caused by the most frequent germs. The surgical treatment of IE consists of total excision of the infected tissues and aims to restore the integrity of valvular functions. Conservative surgical treatment is performed, when possible, otherwise valve replacement is the alternative. The recognition of surgical indications (heart failure, uncontrolled infection, and prevention of embolic risk) is essential to improve the prognosis.

摘要

感染性心内膜炎的治疗。感染性心内膜炎(IE)患者由多学科团队进行护理。治疗包括早期开始的抗生素治疗,根据致病微生物进行调整并延长疗程,在有手术指征时联合手术治疗。在医院开始至少为期两周的肠外抗生素治疗。根据患者的病情进展,可考虑门诊抗生素治疗,对于由最常见微生物引起的IE且病情稳定的患者,可给予口服抗生素。IE的手术治疗包括感染组织的完全切除,旨在恢复瓣膜功能的完整性。尽可能进行保守手术治疗,否则可选择瓣膜置换。识别手术指征(心力衰竭、感染控制不佳和预防栓塞风险)对于改善预后至关重要。

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