31岁小伙“四脏”衰竭，“普通感冒”差点要了命！医生提醒：有这种症状请尽快就医
深圳新闻网2024年4月3日讯（读特新闻记者 陈雯莉）31岁的小张（化名）总是时不时发烧咳嗽，体温最高达40摄氏度。他觉得这是普通感冒，吃点药扛一扛就能转好，没想到一个月后，自己却因为这个“小病”差点丢了性命。近日，深圳市人民医院凭借多学科共同努力，成功抢救了一名因感染性心内膜炎导致全身四个脏器衰竭的患者，创造生命奇迹。记者从深圳市人民医院了解到，小张突然胸闷气促，脸色苍白，无法躺平，被紧急送往深圳市人民医院重症医学科抢救。重症医学科主任医师刘雪燕立即组织队伍，对于患者肺氧合功能差的情况，通过ECMO以增加供氧，为进一步治疗争取时间；对于肝肾出现的严重损害，立刻给予CRRT（连续性肾脏替代治疗），用透析来替代肝肾功能。及时抢救后，小张的缺氧及低血压状况暂时缓解。
在全面检查中，超声科副主任陈立新准确判断该患者为感染性心内膜炎，心脏主动脉瓣赘生物形成、主动脉瓣重度关闭不全，主动脉瓣穿孔可能，心脏功能也几近衰竭。重症医学科团队马上联系心脏大血管外科主任医师孟春营会诊。经过讨论，大家认为通过手术清除小张的心脏感染病灶、恢复瓣膜正常功能是扭转多器官衰竭问题的唯一手段。
感染性心内膜炎的表现。（深圳市人民医院供图）
“重度关闭不全可以理解为‘心门’关不上。”孟春营解释称，正常人的血液经过主动脉瓣和主动脉输送到全身，如果心脏功能受损，人体将无法完成有效的血液循环状态。手术的任务是彻底清除“心门”附近因细菌感染滋生的“组织坏死垃圾”，并完成“新大门”的安装。
要做好这项手术并不容易。孟春营坦言，对多脏器功能不全的患者实施心脏体外循环手术，其中的危险程度不亚于在刀尖上起舞，而且从专业医学常识上看，四个器官系统功能衰竭几乎没有医治生存的可能。在医务人员与患者家属交代了巨大的手术风险并得到同意后，治疗团队马上开始准备手术，“只要有一线希望，也要全力以赴挽救年轻的生命。”
手术过程中，孟春营小心翼翼地为患者切除病变主动脉瓣，彻底清除瓣周脓肿组织，重建左室流出道、主动脉瓣环及部分主动脉窦，置入一枚人工生物瓣。“正常的心脏组织是有韧性的，可以比较轻松地完成手术操作。但小张的瓣膜及周围组织被细菌侵蚀后变得很松脆，容易破裂。”孟春营表示，普通人瓣膜植入十几针就能完成缝合，但小张的情况特殊，使用了异种人工材料，缝合了数百针，才修补重建缺损的心脏结构，保证手术顺利完成并达到远期的效果。
术后，心脏大血管外科主任医师郑奇军根据小张的病情，多次组织科内讨论、院内多学科会诊，重症医学科、呼吸内科、肾内科、感染内科、超声科、临床药学科、康复医学科、营养科共同参与患者的治疗。目前，小张已经康复出院。
医生提醒，如果遇到不明原因长时间反复发热，不要轻易当成普通感冒，建议尽早到医院就诊，排除心脏内膜感染的可能。有心脏瓣膜基础病的人，或免疫力低下的人群，在做一些侵入性的操作如拔牙，痤疮、疖、痈等处理时，要尤其注意败血症的发生。来源：读特客户端
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