感染性心内膜炎合并卒中3例及文献复习

Three cases of infective endocarditis complicated with stroke and the literature review

目的探讨感染性心内膜炎引起的卒中的临床特点、诊疗与预后。方法报道3例我院诊治的感染性心内膜炎合并卒中病例,结合文献对感染性心内膜合并卒中的临床特点、治疗及其预后进行分析总结。结果病例1合并脑梗死及蛛网膜下腔出血,病例2合并脑梗死及肾动脉梗死,病例3合并脑梗死及肺动脉栓塞,分别给予抗感染、抗凝等治疗后,预后良好。文献报道感染性心内膜炎引起的卒中患者中,脑梗死占70%,脑出血占30%。常合并有多器官栓塞。指南推荐一旦怀疑或确诊感染性心内膜炎,应马上开始经验性使用抗生素治疗。感染性心内膜炎合并脑梗死后(4±2)d及(17±11)d手术预后并无差别。溶栓及预防性抗血小板治疗,出血及死亡概率较高。结论感染性心内膜炎合并卒中临床表现多样,经过及时的给予抗感染及手术治疗,可以挽救多数患者的生命。

Objective To investigate the clinical characteristics,diagnosis and prognosis of stroke caused by infective endocarditis. Methods To report three cases of infectious endocarditis complicated with stroke cured in our hospital and summarize the clinical characteristics,treatment and prognosis combined with the literature. Results First one complicated with cerebral infarction and subarachnoid hemorrhage at the same time. The second one complicated with cerebral infarction and renal artery infarction. Last one complicated with cerebral infarction and pulmonary embolism. After treatment with antibiotic or anticoagulation,the prognosis is good. In the literature reviews,cerebral infarction accounted for 70% and cerebral hemorrhage accounted for 30%. Often combined with multiple organ embolism. Guidelines recommend that once suspected or confirmed infective endocarditis,empirical treatment with antibiotics should immediately begin. The prognosis of surgery after infective endocarditis with cerebral infarction is no difference between（ 4 ＋ 2） days and（ 17 ＋ 11） days. The prognosis is poor with treatment of thrombolysis and prophylactic antiplatelet. Conclusion There are various clinical manifestations of infective endocarditis with stroke. With timely treatment of anti-infective and surgical,lives of patients can be saved.