Davenport J, Hart R G
Department of Veterans Affairs Medical Center, Minneapolis, Minnesota.
Stroke. 1990 Jul;21(7):993-9. doi: 10.1161/01.str.21.7.993.
We retrospectively reviewed the clinical characteristics and outcomes of 61 patients with 62 episodes of prosthetic valve endocarditis, paying particular attention to neurologic complications (stroke). Atypical features of the group included a benign outcome of early postoperative infection (18% mortality) and a high stroke morbidity and mortality rate with Staphylococcus epidermidis infections. Eleven patients (18%) suffered an embolic stroke, most less than or equal to 3 days after diagnosis and before the initiation of antimicrobial therapy; the rate of embolic stroke recurrence was low (9%). The risk of embolic stroke was lower with bioprosthetic than with mechanical valves. No protective effect of anticoagulation therapy with warfarin was observed. Six patients (8%) suffered brain hemorrhage due to septic arteritis, brain infarction, or undetermined causes; no specific risk of hemorrhagic stroke was evident with anticoagulation therapy. Antibiotic treatment appears to be more important than anticoagulation to prevent neurologic complications in patients with prosthetic valve endocarditis.
我们回顾性分析了61例患者62次人工瓣膜心内膜炎发作的临床特征和结局，尤其关注神经系统并发症（中风）。该组的非典型特征包括术后早期感染的良性结局（死亡率18%）以及表皮葡萄球菌感染导致的高中风发病率和死亡率。11例患者（18%）发生栓塞性中风，多数在诊断后且在开始抗菌治疗前3天内；栓塞性中风复发率较低（9%）。生物瓣膜发生栓塞性中风的风险低于机械瓣膜。未观察到华法林抗凝治疗的保护作用。6例患者（8%）因感染性动脉炎、脑梗死或不明原因发生脑出血；抗凝治疗未显示出血性中风的特定风险。在预防人工瓣膜心内膜炎患者的神经系统并发症方面，抗生素治疗似乎比抗凝治疗更重要。
