合并脑血管并发症的感染性心内膜炎40例外科治疗体会

张校铭; 余云生; 沈振亚; 华菲; 张新鹃; 赵云峰

doi:10.13898/j.cnki.issn.1000-2200.2016.05.006

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

合并脑血管并发症的感染性心内膜炎40例外科治疗体会

张校铭 , 余云生 , 沈振亚 , 华菲 , 张新鹃 , 赵云峰

文章导航 > 蚌埠医学院学报 > 2016, 41 > 5: (577-579)

引用本文:

Citation:

合并脑血管并发症的感染性心内膜炎40例外科治疗体会

1. 苏州大学附属第一医院心脏大血管外科, 江苏苏州 215000;
2. 山东中医药高等专科学校, 山东烟台 264100

作者简介: 张校铭(1988-),男,硕士研究生.

基金项目:
国家自然科学基金青年科学基金项目(81401316)
中图分类号: R542.41

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

1. Department of Cardiovascular Surgery, The First Hospital of Soochow University, Suzhou Jiangsu 215000, China;
2. Shandong College of Traditional Chinese Medicine, Yantai Shandong 264100, China
CLC number: R542.41

摘要: 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。
- 感染性心内膜炎 /
- 脑血管并发症 /
- 外科治疗
Abstract: 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.
- infective endocarditis /
- cerebrovascular vascular complication /
- surgical treatment

[1]	胡盛寿.阜外医院心脏外科手册[M].北京:人民卫生出版社,2006:56.
[2]	FRANCK T,JEAN-FRANÇOIS A,CHRISTOPHE T,et al.Impact of cerebrovascular complications on mortality and neurologic outcome during infective endocarditis:a prospective multicentre study[J].Eur Heart J,2007,28(9):1155.
[3]	GARCÍA-CABRERA E,FERNÁNDEZ-HIDALGO N,ALMIRANTE B,et al.Neurological complications of infective endocarditis:risk factors,outcome,and impact of cardiac surgery:a multicenter observational study[J].Circulation,2013,127(23):2272.
[4]	ANGSTWURM K,BORGES AC,HALLE E,et al.Timing the valve replacement in infective endocarditis involving the brain[J].J Neurol,2004,251(10):1220.
[5]	何锦霞,于岚.超声心动图对先天性心脏病合并感染性心内膜炎的诊断价值[J].中国超声医学杂志,2010,26(5):473.
[6]	Westphal N,Plicht B,Naber C.Infective endocarditis——prophylaxis,diagnostic criteria,and treatment[J].Dtsch Arztebl Int,2009,106(28/29):481.

[1]	官建中 , 周建生 , 肖玉周 , 吴敏 , 张长春 . 青少年腰椎间盘突出症的临床分析. 蚌埠医学院学报, 2011, 36(10): 1067-1068,1070.
[2]	陈伟强 , 张弋 . 小儿硬膜下积液的外科治疗. 蚌埠医学院学报, 2004, 29(5): 426-427.
[3]	张孝龙 . 老年患者左半结肠癌合并梗阻手术治疗38例分析. 蚌埠医学院学报, 2011, 36(7): 724-725.
[4]	程晓峰 , 景华 , 李德闽 , 胡小南 , 李忠东 , 董国华 , 罗立国 , 张小华 . 感染性心内膜炎外科治疗34例. 蚌埠医学院学报, 2009, 34(3): 223-225.
[5]	杨玮 . 肥胖2型糖尿病患者代谢异常及心脑血管并发症分析. 蚌埠医学院学报, 2013, 37(12): 1593-1595.
[6]	周晓 , 刘学刚 , 王祖义 , 唐震 , 刘以尧 , 李小军 , 施超 , 段贵新 . 肺隔离症诊断及外科治疗7例分析. 蚌埠医学院学报, 2011, 36(8): 805-806,809.
[7]	张德恕 , 王芳荣 , 张伟 , 胡全芳 . 准分子激光原位角膜磨镶术并发症的预防和治疗. 蚌埠医学院学报, 2006, 31(4): 402-403.
[8]	于勤 . 冠心病介入治疗中并发症的观察与护理. 蚌埠医学院学报, 2009, 34(8): 741-742.
[9]	齐峰 . 血浆置换治疗重型肝炎58例常见并发症分析. 蚌埠医学院学报, 2011, 36(6): 598-599.
[10]	陈玲 , 江怀芝 , 黄培英 , 赵春苗 . 经动脉介入治疗原发性肝癌术后并发症的观察与护理. 蚌埠医学院学报, 2011, 36(10): 1151-1153.
[11]	房君 , 江燕 . 肝癌介入治疗术后并发症的预防与护理体会. 蚌埠医学院学报, 2012, 36(11): 1364-1366.
[12]	贾苏豫 , 石增刚 , 张亮 , 张隽 . 不同途径冠状动脉介入治疗术后并发症的观察及护理. 蚌埠医学院学报, 2013, 37(11): 1511-1512.
[13]	王晓天 , 贾国法 , 单红 , 张迪 , 吴丽颖 . 肝移植3例术后胆道并发症内镜诊治疗效分析. 蚌埠医学院学报, 2014, 39(11): 1540-1541.
[14]	乔艳 , 郭普 , 刘晓红 , 李伟 . 持续质量改进在预防人工肝治疗并发症中的应用效果. 蚌埠医学院学报, 2018, 43(5): 673-675. doi: 10.13898/j.cnki.issn.1000-2200.2018.05.034
[15]	顾江魁 , 葛阳 , 陶立伟 . 结核性毁损肺外科治疗34例分析. 蚌埠医学院学报, 2010, 35(4): 383-384.
[16]	宋国智 , 宋利宏 , 王霞 , 晁艳艳 , 常成 , 陈建军 , 李海红 , 张钧 . 脑干海绵状血管瘤显微外科手术治疗的有效性及其预后. 蚌埠医学院学报, 2017, 42(10): 1363-1364,1367. doi: 10.13898/j.cnki.issn.1000-2200.2017.10.021
[17]	刘婕 , 赵淑丽 , 张群 . 微信聊天机器人干预对血液透析动静脉内瘘病人心理状态、治疗依从性及并发症的影响. 蚌埠医学院学报, 2023, 48(8): 1121-1125. doi: 10.13898/j.cnki.issn.1000-2200.2023.08.023
[18]	刁秀竹 , 陈薇 . 维持性血液透析动静脉内瘘并发症防治. 蚌埠医学院学报, 2010, 35(3): 273-275.
[19]	刘利敏 , 陈勇 , 寇玉彬 , 吴驰 , 曾小兵 , 陆宝华 . 困难性胆囊切除术后并发症27例分析. 蚌埠医学院学报, 2013, 37(4): 429-430.
[20]	虞春宜 . 永久性心脏起搏器植入280例远期并发症分析. 蚌埠医学院学报, 2016, 41(11): 1455-1456,1459. doi: 10.13898/j.cnki.issn.1000-2200.2016.11.015

点击查看大图

计量

文章访问数: 3754
HTML全文浏览量: 472
PDF下载量: 146
被引次数: 0

合并脑血管并发症的感染性心内膜炎40例外科治疗体会

作者简介: 张校铭(1988-),男,硕士研究生.

1. 苏州大学附属第一医院心脏大血管外科, 江苏苏州 215000;
2. 山东中医药高等专科学校, 山东烟台 264100

收稿日期: 2015-11-19

基金项目: 国家自然科学基金青年科学基金项目(81401316)

关键词:

摘要: 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。

English Abstract

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

1. Department of Cardiovascular Surgery, The First Hospital of Soochow University, Suzhou Jiangsu 215000, China;
2. Shandong College of Traditional Chinese Medicine, Yantai Shandong 264100, China

Received Date: 2015-11-19

Abstract: 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.