合并脑血管并发症的感染性心内膜炎40例外科治疗体会

目的:探讨合并脑血管并发症的感染性心内膜炎的诊断标准和手术指征、手术时机的选择,总结临床治疗经验。方法:回顾性分析经外科手术治疗的术前合并脑血管并发症的40例感染性心内膜炎患者资料。入院后根据血培养结果选择敏感抗生素,并行营养神经等对症治疗;选择合适手术时机,术中彻底清除病灶,彻底矫治心脏合并畸形;术后常规给予强心、利尿等对症治疗,并根据血培养结果继续应用敏感抗生素。结果:术后早期病死6例,其中再发脑出血2例,恶性心律失常1例,重度肺部感染1例,低心排综合征1例,肾衰竭继发循环衰竭1例;其余34例均治愈出院。结论:外科治疗合并脑血管并发症的感染性心内膜炎治疗效果总体满意。早期明确诊断、合理掌握手术时机、术中彻底清除病灶、术后规范抗感染及抗凝治疗是关键。

Experience of the surgical treatment of infective endocarditis complicated with cerebral vascular complication in 40 cases

Objective:To investigate the diagnosis, surgical indications and timing of surgical treatment of infective endocarditis complicated with cerebral vascular complications for summarizing the clinical experience. Methods:The data of the 40 patients with infective endocarditis complicated with preoperative complication before operation were retrospectively analyzed. After admission, the patients were treated with sensitive antibiotics according to the blood culture finding combined with nerve nutrition. The appropriate timing of surgery was selected,thorough removing the lesion and correcting cardiac malformations were implemented during the period of operation. After operation,the patients were treated with cardiotonic,diuresis and sensitive antibiotics. Results:The early postoperative death in 6 cases,recurrence of cerebral hemorrhage in 2 cases,malignant arrhythmia in 2 cases,severe pulmonary infection in 1 case, low cardiac output syndrome in 1 case and circulatory failure secondary to renal failure in 1 case were found, 34 cases cured. Conclusions:The surgical treatment effect in patients with infective endocarditis complicated with cerebral vascular complication is satisfaction. The early diagnosis,reasonable grasping the timing of surgery,thorough removing the lesions,postoperative standard anti-infection and anticoagulant therapy are the key.