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本文报告二例继发于链球菌性心内膜炎的有明显血液动力学改变的瓣膜梗阻。这是一种罕见的合并症,需要充分认识和迅速处理。 病例1:49岁,女性,因发热、寒战、呼吸困难、恶心、呕吐和腹泻4天入院。所有的血培养都有血链球菌生长。经胸心脏超声发现在二尖瓣心房面有-1.2×1.8cm的堵塞性赘生物(图略),并发现有左房扩大,心包后有少量积液。病人过去无瓣膜性心脏病症状和充血性心力衰竭的症状。开始计划进行六周静滴青霉素。因有心动过速和肺充血,合用β-受体阻滞剂和利尿药。在抗生素治疗第15天后,插心导管,发现平均右房压为5mmHg,右室压60/10mmHg。肺动脉压60/30～35mmHg。肺毛细血管楔状压为28mmHg,心输出量4.3升/分。动静脉氧分压差为4.
This article reports two cases of valvular obstruction with significant hemodynamic changes secondary to streptococcal endocarditis. This is a rare complication that needs to be fully understood and promptly treated. Case 1: 49 years old, female, admitted to hospital for 4 days due to fever, chills, dyspnea, nausea, vomiting and diarrhea. All blood cultures have Streptococcus sobrinus growth. Transthoracic echocardiography found in the mitral valve atrial occlusion of -1.2 × 1.8cm (Figure omitted) and found a left atrial enlargement, a small amount of effusion after pericardium. The patient had no symptoms of valvular heart disease and congestive heart failure in the past. Start planning for intravenous infusion of penicillin for six weeks. Due to tachycardia and pulmonary congestion, combined beta-blockers and diuretics. After antibiotic treatment on day 15, the catheter was inserted and found to have a mean right atrial pressure of 5 mmHg and a right ventricular pressure of 60/10 mmHg. Pulmonary artery pressure 60/30 ~ 35mmHg. Pulmonary capillary wedge pressure was 28 mmHg, cardiac output 4.3 l / min. Arteriovenous oxygen partial pressure of 4.