合并脑血管并发症的感染性心内膜炎的外科治疗  

Surgical management of infective endocarditis with cerebrovascular complications

作　　者：王常田[1] 许飚[1] 张雷[1] 吴海卫[1] 李忠东[1] 景华[1] 李德闽[1] 

机构地区：[1]南京军区南京总医院心胸外科,210002

出　　处：《中华外科杂志》2015年第6期442-445,共4页Chinese Journal of Surgery

摘　　要：目的 总结合并脑血管并发症感染性心内膜炎的外科治疗结果,探讨合适的手术指征和时机.方法 回顾性分析2007年12月至2013年12月在南京军区南京总医院心胸外科接受手术的26例术前合并脑血管并发症感染性心内膜炎患者的临床资料.其中男性17例,女性9例,年龄18 ～ 72岁,平均年龄（42±14）岁.单纯主动脉病变8例,单纯二尖瓣病变12例,主动脉瓣和二尖瓣均受累5例,主动脉瓣病变合并室间隔缺损1例.术前脑梗死25例,脑出血1例.共累及瓣膜31个,机械瓣置换25枚,生物瓣置换4枚;2例行二尖瓣成形.结果 脑血管并发症出现14 d以内手术3例,14～ 21 d手术13例,21 d以上手术10例.脑血管并发症出现至手术间隔时间平均（20±4）d.术中共发现瓣膜赘生物33个,最大径平均（10 ±4）mm,其中19个位于二尖瓣.住院死亡2例.1例1年后人工瓣感染再次手术治愈.其余患者经随访心功能（纽约心脏病协会分级）均恢复为Ⅰ～Ⅱ级.结论 合并脑血管并发症的感染性心内膜炎患者,积极的外科治疗可有效提高治愈率.Objective To investigate the result of surgical treatment of active infective endocarditis in patients with recent cerebrovascular events,and to evaluate the optimal indication and timing of surgical intervention.Methods The clinical data of 26 patients with cerebrovascular complications before surgery Between December 2007 and December 2013 were analyzed retrospectively.There were 17 male and 9 female patients,aged （42 ± 14） years.Types of disease included single aortic valvular disease （n =8）,single mitral valvular disease （n =12）,multiple valvular disease （n =5）,and aortic valvular disease with ventricular septal defect （n =1）.Type of cerebrovascular complication included cerebral infarction （n =25） and cerebral hemorrhage （n =1）.Thirty-one valves were involved in 26 patients,mechanical prosthetic valve replacement （n =25）,bioprosthetic valve replacement （n =4）,and mitral valve repair （n =2）.Results The interval between onset of cerebrovascular event and surgical intervention was less than 14 days （n =3）,14 to 21 days （n =13）,over 21 days （n =10）,and the mean was （20 ±4） days.There were 33 vegetations found intraoperatively.The mean size of vegetations was （10 ± 4） mm and 19 were found in mitral valve.Two patients died in hospital.One case relapsed after 1 year and underwent reoperation for prosthetic valve endocarditis.The remaining patients recovered with cardiac function of New York Heart Association class Ⅰ to Ⅱ after the period of 3 months to 5 years follow-up.Conclusions Appropriate surgery may effectively improve the outcome of IE patients with cerebrovascular complications.The surgical indications and risks of further neurologic deterioration after cardiac surgery should be assessed comprehensively before surgical intervention.

关 键 词：心内膜炎 细菌性 脑血管障碍 心脏外科手术 

分 类 号：R654.2[医药卫生—外科学]