Ishikawa S, Ohtaki A, Takahashi T, Sato Y, Koyano T, Hasegawa Y, Yamagishi T, Ogino T, Ohki S, Kamiyoshihara M, Morishita Y
Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan.
J Cardiovasc Surg (Torino). 1998 Feb;39(1):95-7.
The causes and management of postoperative fever were studied.
During a four-year-period beginning in January of 1991, high fever over 38.5 degrees C max occurred in twenty-five (6%) out of 395 patients who underwent cardiovascular surgery.
Nine of the patients (28%) evidenced bacteriological infections as follows; 3 cases of mediastinitis, 2 cases of respiratory tract infection, 1 case of MRSA colitis and a wound infection in one case. The three patients with mediastinitis died and the two cases of MRSA were detected from the culture of pacemaker leads. Bacteriological infection was not detected in other 18 (72%) patients with fever. However, we speculated that the clinical causes of fever in 9 out of 18 patients were as follows; catheter fever in 3 patients, acalculous cholecystitis in 2, fungus infection in 2, aseptic meningitis in one and viral myelitis in one patient. Two patients with acalculous cholecystitis recovered after percutaneous transhepatic gallbladder drainage. The causes of fever were not apparent in nine patients, however the source might be related to artificial prostheses used intraoperatively in five patients. C-reactive protein (CRP) was elevated beyond 10 mg/dl in 13 (52%) of the 25 patients. CRP increased in all seven bacteriologically positive patients and in six (32%) of the bacteriologically negative patients.
Precise and prompt bacterial examinations are necessary in patients with CRP elevation because the origins of fever were bacteriological in only 28% of the patients with a high fever. Good prognoses may be obtained by suitable management in bacteriologically negative patients.
对术后发热的原因及处理进行了研究。
在1991年1月开始的四年期间，395例接受心血管手术的患者中有25例（6%）出现最高体温超过38.5摄氏度的高热。
9例患者（28%）有如下细菌感染证据；3例纵隔炎，2例呼吸道感染，1例耐甲氧西林金黄色葡萄球菌结肠炎，1例伤口感染。3例纵隔炎患者死亡，2例耐甲氧西林金黄色葡萄球菌感染是从起搏器导线培养物中检测到的。其他18例（72%）发热患者未检测到细菌感染。然而，我们推测18例患者中有9例发热的临床原因如下；3例导管热，2例无结石性胆囊炎，2例真菌感染，1例无菌性脑膜炎，1例病毒性脊髓炎。2例无结石性胆囊炎患者经皮经肝胆管引流术后康复。9例患者发热原因不明，不过其中5例患者发热源可能与术中使用的人工假体有关。25例患者中有13例（52%）C反应蛋白（CRP）升高超过10mg/dl。所有7例细菌学检查阳性的患者以及6例（32%）细菌学检查阴性的患者CRP均升高。
CRP升高的患者需要进行精确且及时的细菌学检查，因为高热患者中仅有28%的发热源是细菌学方面的。对细菌学检查阴性的患者进行适当处理可能获得良好预后。
