感染性心内膜炎患者手术后卒中临床研究  

The clinical study of postoperative stroke in patients with infective endocarditis

作　　者：曹贵方[1] 曹莉[1] 王胜洵[2] 穆军升[2] CAO Guifang;CAO Li;WANG Shengxun;MU Jumheng(Department of Neurology, Beijing Anzhen Hospital, Capital Medical University Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所神经内科,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科,100029

出　　处：《心肺血管病杂志》2019年第6期665-668,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:研究感染性心内膜炎(IE)手术后卒中的临床特点,为卒中的预防提供临床参考。方法:筛选北京安贞医院近15年收治的15岁以上IE患者中发生手术后卒中者,回顾性分析了这些手术后卒中患者的临床以及实验室和影像学资料。结果:在705例手术治疗的IE患者中,术后卒中发生率为2.11%(15例)。卒中患者以男性为主(80%),平均年龄(52.3±15.9)岁。出血性卒中10例,缺血性卒中5例。IE术后缺血性卒中患者最常见心脏基础疾病为风湿性心脏病(60%),梗死病灶常累及多个血管分布区(60%)。出血性卒中以男性多见(90%),基础疾病以主动脉瓣二叶畸形最多见(40%),赘生物主要位于主动脉瓣(80%),最常见表现为昏迷(70%),脑叶出血最多见(80%),可伴有其他部位出血。2例为蛛网膜下腔出血。患者颅内出血时INR值最高为2.15,最低仅0.86。6例患者HAS-BLED评分≥3分。8例(55%)卒中患者(包括7例为出血性卒中和1例缺血性卒中)临床死亡。结论:IE手术后卒中以出血性卒中为多见,且致死率高要引起临床重视。Objective: To study the clinical features of postoperative stroke in patients with infective endocarditis(IE) and provide clinical evidence for the prevention of stroke. Methods: Patients with post-operative stroke in IE patients(aged above fifteen years old)admitted to Beijing Anzhen Hospital for fifteen years were screened,and their clinical, laboratory and imaging data were retrospectively analyzed. Results: Of the 705 surgically treated IE patients, the incidence of post-operative stroke in was 2.1%(15 cases) in IE patients who underwent surgery at Beijing Anzhen Hospital. Stroke patients were predominantly male(80%) with an average age of(52.33±15.92) years. There were 10 cases of hemorrhagic stroke and 5 cases of ischemic stroke. The most common underlying disease of patients with ischemic stroke was rheumatic heart disease(60%). The infarct lesions often involve multiple vascular distribution areas(60%). Hemorrhagic stroke was more common in men(90%). The most common underlying disease of hemorrhagic stroke was Bicuspid aortic valve(40%). The vegetations were mainly located in the aortic valves(80%). The most common manifestation was coma(70%). Eight patients showed as lober hemorrhage,and 2 cases showed as subarachnoid hemorrhage(SAH). The INR value of the patient with hemorrhagic stroke range between 0.86 and 2.15. Six patients had a HAS-BLED score of ≥3 points. Eight patients(55%) died of postoperative stroke(including 7 with hemorrhagic stroke and 1 with ischemic stroke). Conclusions: Hemorrhagic stroke was common type in postoperative stroke in patients with IE,and should be given clinical attention because of its high mortality rate.

关 键 词：感染性心内膜 手术后卒中 出血性卒中 

分 类 号：R54[医药卫生—心血管疾病]