感染性心内膜炎并脑梗死患者手术时机的选择

Option of surgical treatment of infective endocarditis with cerebral infarction

目的探讨感染性心内膜炎(infective endocarditis, IE)并脑梗死患者的手术时机。方法 IE并脑梗死患者31例,根据末次脑梗死至手术时间分为2组。早期手术组9例,于末次脑梗死后<4周行手术治疗;晚期手术组22例,于末次脑梗死后≥4周行手术治疗。比较2组临床资料,手术情况,术后早期病死率、并发症发生率,随访观察远期生存率。结果早期手术组术前白细胞计数[(8.5±5.6)×10~9/L]高于晚期手术组[(7.7±3.9)×10~9/L](P<0.05);早期手术组瓣膜手术术式、主动脉阻断时间、体外循环时间、呼吸机应用时间、ICU住院时间与晚期手术组比较差异均无统计学意义(P>0.05);早期手术组早期病死率(11.1%)、术后早期并发症发生率(55.6%)与晚期手术组(9.1%、36.4%)比较差异无统计学意义(P>0.05);出院后随访(43.1±26.9)个月,8例失访,3例死亡,NYHA心功能恢复至Ⅰ～Ⅱ级,无IE复发或加重;Kaplan-Meier生存曲线结果显示,早期手术组术后6 a生存率与晚期手术组比较差异无统计学意义(P>0.05)。结论与晚期手术比较,IE并脑梗死患者早期积极外科手术治疗未增加术后早期并发症发生率及远期病死率。

Objective To explore the option of surgery of infective endocarditis (IE)complicated with cerebral infarction.Methods IE complicated with cerebral infarction were divided into 9patients receiving surgery within 4weeks after the latest cerebral infarction(early surgery group)and 22patients receiving surgery over 4weeks after the latest cerebral infarction(late surgery group).The clinical data,surgery,early mortality after surgery,complications rate,and long-term survival rate were compared between two groups.Results The white blood cell count was significantly higher in early surgery group((8.5±5.6)×10^9/L)than that in late surgery group((7.7±3.9)×10^9/L)(P<0.05).There were no significant differences in the valve operation types,aortic cross clamp time,cardiopulmonary bypass time,the duration of ventilator and ICU stay between two groups(P>0.05).The early mortality and early complication rate after operation showed no significant differences between early surgery group (11.1%,55.6%)and late surgery group (9.1%,36.4%)(P>0.05).Eight patients were lost during follow-up,and the rest patients were followed up for (43.1±26.9)months,in which 3patients died.Heart function recovered to NYHA classⅠ-Ⅱ,with no IE recurrence or aggravation.Kaplan-Meier analysis showed no significant difference in the 6-year survival rate between two groups (P>0.05).Conclusion Early surgical treatment does not increase the early complication rate after surgery and long-term mortality rate in IE patients with cerebral infarction.