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目的:总结有关支架感染患者的临床表现、检查方法、处理及预后等,促进临床对该少见并发症的了解,提高诊治成功率。方法:通过Pubmed、EMBASE、EBSCO、ScienceDirect、CNKI、VIP和万方数据库等检索有关冠脉支架感染的文献报道。结果:总共有29篇文献,31例患者,均为个案报道。男性占87.1%。多数患者在术后3个月内起病(76.7%),首发症状多为发热(90%)、胸痛(53.3%)、气促(20%)、乏力(20%)。所有患者均表现为发热和(或)胸痛,可先后或同时出现。不论是金属裸支架,还是各种药物洗脱支架均可出现支架相关感染。血液和(或)组织液可培养出细菌生长,分离培养的G+细菌占87.1%。其中83.9%为金黄色葡萄球菌。采用心脏超声、CT、核磁共振、冠脉造影等多种检查手段可发现支架局部动脉瘤、假性动脉瘤、局部脓肿和心包积液(化脓性),部分患者可出现感染性心内膜炎、支架断裂、支架血栓、心脏破裂等。除药物治疗和带膜支架覆盖方法,多数患者需药物+外科手术治疗。尽管积极治疗,病死率仍非常高(43.3%)。结论:经皮冠脉介入植入支架术后出现发热、胸痛要提防支架感染,早期诊断并积极采取药物+外科手术治疗可望降低病死率。
OBJECTIVE: To summarize the clinical manifestations, examination methods, treatment and prognosis of patients with stent-infection, to promote clinical understanding of this rare complication and to improve the success rate of diagnosis and treatment. Methods: The literature about coronary stent infection was searched through Pubmed, EMBASE, EBSCO, ScienceDirect, CNKI, VIP and Wanfang database. Results: A total of 29 articles, 31 patients, are reported as individual cases. Men make up 87.1%. The majority of patients were diagnosed within 3 months of surgery (76.7%). The first symptoms were mostly fever (90%), chest pain (53.3%), shortness of breath (20%), and weakness (20%). All patients presented with fever and / or chest pain, either sequentially or simultaneously. Stents-related infections can occur with either bare metal stents or with various drug-eluting stents. Bacteria grew in the blood and / or tissue fluid, accounting for 87.1% of G + bacteria isolated and cultured. 83.9% of them were Staphylococcus aureus. Local echocardiography, pseudoaneurysm, local abscess and pericardial effusion (suppurative) can be found by using a variety of examination methods such as echocardiography, CT, MRI and coronary angiography. Some patients may have infective endocarditis , Stent fracture, stent thrombosis, heart rupture and so on. In addition to medication and stent-graft methods, most patients require medication + surgery. Despite active treatment, the case fatality rate is still very high (43.3%). CONCLUSION: Fever occurs after percutaneous coronary intervention in stenting. Chest pain should be guarded against stent infection. Early diagnosis and active use of drugs plus surgery are expected to reduce mortality.