原发心脏疾病并发心源性脑梗死69例临床分析

Clinical analysis of primary heart diseases complicated with cardiogenic cerebral infarction in 69 cases

目的探讨原发心脏疾病并心源性脑梗死的临床特点。方法分析行心内直视手术的69例原发心脏疾病并心源性脑梗死患者临床资料,记录原发心脏疾病种类、末次心源性脑梗死发生至实施心脏手术的时间以及治疗、随访结果。结果本组心脏瓣膜病37例,感染性心内膜炎19例,心脏黏液瘤7例,黏液瘤综合征1例,冠心病合并左心室室壁瘤5例;手术治愈66例,死亡3例,其中末次心源性脑梗死发生2个月内手术者22例,死亡2例,2个月后手术者47例,死亡1例;术后随访(38.7±13.1)个月,无新增死亡病例和再次脑梗死发生。结论心源性脑梗死其原发心脏疾病种类多样,心脏手术时机需视心脏病变情况及脑梗死严重程度而决定;及时诊断和治疗原发心脏疾病是预防再次或多次脑梗死的关键。

Objective To explore the clinical characteristics of primary heart diseases complicated with cardiogenic cerebral infarction.Methods The data of primary heart diseases complicated with cardiogenic cerebral infarction undergoing open heart surgery in 69 patients were analyzed and recorded the types of primary heart diseases,the interval from the last occurrence of cardiogenic cerebral infarction to cardiac surgery,the result of operation and the follow-up result.Results There were 37 cases of vavular heart disease,19 cases of infective endocarditis,7cases of cardiac myxoma,1case of myxoma syndrome and 5cases of coronary heart disease complicated with left ventricular aneurysm.Sixty-six patients were cured,and 3patients died.In 22 patients undergoing cardiac surgery within two months after the last occurrence of cerebral infarction,2patients died,and in 47 patients undergoing cardiac surgery beyond 2months,one patient died.In the follow-up survey for（38.7±13.1）months,no newly death and no recurrent cerebral infarction occurred.Conclusion Primary heart diseases are varied in the patients with cardiogenic cerebral infarction.The timing of operation depends on cardiac lesion and the severity of cerebral infarction.The timely diagnosis and treatment of primary cardiac diseases is the key to avoiding the second and repeated occurrence of cerebral infarction.