论文部分内容阅读
脑梗塞后急性期,此期如倣心脏手术,因多伴发心功能不全、重症感染和意识障碍等,因此,时间和适应证的选择直接影响预后。脑梗塞分为脑血栓和脑栓塞二种,心源性脑梗塞即脑栓塞,发病率占缺血性脑血管障碍的15%。基础疾病是①无瓣膜疾病的心房纤颤和合并心脏疾病的房颤;②风湿性心瓣膜病,特别是二瓣狭窄;③心肌梗塞;④心肌病;⑤感染性心内膜炎(IE);⑥非细菌性血栓性心内膜炎;⑦人工瓣膜;⑧心房粘液瘤;⑨二尖瓣脱垂;⑩反常性栓塞;(11)心脏起博器的应用。其发病率,非瓣膜病性房颤45%,急性心肌梗塞15%(3%/4周),左室瘤10%,风心病10%,人工瓣膜10%,其他。心源性脑梗塞患者心脏手术的适应证少,大多需内科治疗。一、左房血栓性脑梗塞1.二尖瓣狭窄:约20%(4%/年)发生脑梗塞,如合并心房纤颤、左室扩大、心功不全及左房血栓,则发生率增加。特别是有房颤比单纯狭窄危险性增加3～7倍。栓塞再发者约30～75%(10%/年)以第一年内最多。用抗凝治疗可减少再发率,但不能完全预
After acute cerebral infarction, this period, such as imitation of cardiac surgery, due to multiple heart failure, severe infection and disturbance of consciousness, therefore, the choice of time and indications directly affect the prognosis. Cerebral infarction is divided into two kinds of cerebral thrombosis and cerebral embolism, cerebral infarction or cerebral infarction, the incidence of ischemic cerebrovascular disorders accounted for 15%. The underlying diseases are atrial fibrillation with valvular disease and atrial fibrillation with heart disease; rheumatic valvular disease, especially two stenosis; myocardial infarction; cardiomyopathy; infective endocarditis (IE) ; ⑥ non-bacterial thrombotic endocarditis; ⑦ artificial valve; ⑧ atrial myxoma; ⑨ mitral valve prolapse; ⑩ abnormal embolism; (11) the application of pacemakers. The incidence of non-valvular atrial fibrillation 45%, acute myocardial infarction 15% (3% / 4 weeks), left ventricular tumor 10%, rheumatic heart disease 10%, prosthetic valve 10%, others. Cardiac surgery in patients with cardiopulmonary indications less, most of the need for medical treatment. First, left atrial thrombotic cerebral infarction 1. Mitral stenosis: about 20% (4% / year) of cerebral infarction, such as with atrial fibrillation, left ventricular enlargement, cardiac insufficiency and left atrial thrombosis, the incidence increased . In particular, there is a 3 to 7 times greater risk of atrial fibrillation than simple stenosis. Embolism recurrence about 30 ~ 75% (10% / year) in the first year up. With anticoagulant therapy can reduce the recurrence rate, but not completely pre-