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目的：确定先天性心脏病活动期感染性心内膜炎(active infective endocarditis，AIE)的手术指征。方法：于2003-2011 年从71 个机构数据库中调查并采集247 例患有感染性心内膜炎的儿童及成人先天性心脏病(congenital heart disease，CHD)患者数据，其中74 例(30%)进行了AIE 手术治疗。回顾性分析患者的年龄、性别、感染心内膜炎前对CHD的诊断、致病微生物和感染部位等数据。结果：与AIE 手术治疗必要性显著相关的指标是感染性心内膜炎(infective endocarditis，IE)病发前对心脏异常的诊断缺乏、主动脉瓣IE、瓣周脓肿、心力衰竭以及抗生素发生变化。逐步逻辑回归方程分析结果表明瓣周脓肿、心力衰竭以及抗生素改变是先天性心脏病患者进行AIE 手术治疗必要性的独立决定因素。结论：对IE 合并CHD 的患者而言，当心力衰竭、瓣周脓肿或抗生素变化发生时，手术可作为治疗AIE 的一种手段。

英文摘要:

Objective:To determine the surgical indications for active infective endocarditis (AIE) in congenital heart diseases, this study was conducted.Methods:IE related data of 247 patients of congenital heart disease (CHD) were collected from 71 institutional databases from 2003 to 2011. Then a retrospective observational cohort multi-center study was conducted on data such as age, gender, underlying heart disease, diagnosis about CHD before IE episode, causative organisms and sites of infection.Results:The lack of diagnosis of cardiac disorders before the onset of IE, aortic valve IE, perivascular abscess, presence of heart failure, and change of antibiotics were identified by the present study as factors significantly associated with the need for surgery of AIE. Then a stepwise logistic regression analysis were conducted and results demonstrated independent determinant factors (i.e. perivascular abscess, heart failure and antibiotics change) for the need for surgical treatment of AIE in CHD patients.Conclusion:Surgery should be considered for CHD patients with AIE following the presence of heart failure, a perivascular abscess, or a change in antibiotics.

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