CAJ | 학술논문

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.
목적 총결합병뇌혈관병발증감염성심내막염적외과치료결과,탐토합괄적수술지정화시궤.방법 회고성분석2007년12월지2013년12월재남경군구남경총의원심흉외과접수수술적26례술전합병뇌혈관병발증감염성심내막염환자적림상자료.기중남성17례,녀성9례,년령18 ～ 72세,평균년령(42±14)세.단순주동맥병변8례,단순이첨판병변12례,주동맥판화이첨판균수루5례,주동맥판병변합병실간격결손1례.술전뇌경사25례,뇌출혈1례.공루급판막31개,궤계판치환25매,생물판치환4매;2례행이첨판성형.결과 뇌혈관병발증출현14 d이내수술3례,14～ 21 d수술13례,21 d이상수술10례.뇌혈관병발증출현지수술간격시간평균(20±4)d.술중공발현판막췌생물33개,최대경평균(10 ±4)mm,기중19개위우이첨판.주원사망2례.1례1년후인공판감염재차수술치유.기여환자경수방심공능(뉴약심장병협회분급)균회복위Ⅰ～Ⅱ급.결론 합병뇌혈관병발증적감염성심내막염환자,적겁적외과치료가유효제고치유솔.
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.