超声心动图诊断感染性心内膜炎的临床价值

目的 评价超声心动图在感染性心内膜炎(infective endocarditis，IE)诊断中的价值。方法 分析总结38例IE患者的临床和超声心动图资料。结果 IE多发生于原有器质性心脏病基础上，以风心病和先心病为主。赘生物有附着位置、大小、形态及随病程变化多种超声特点。超声心动图可检出瓣膜脱垂、腱索断裂和瓣周脓肿等心脏内并发症。结论 超声能为临床提供IE患者的基础心脏病因、诊断、鉴别诊断、指导治疗和判断预后等具有重要价值的信息。     

小儿感染性心内膜炎临床特点的探讨

目的：探讨小儿感染性心内膜炎(IE)的临床特点。方法：对该院近12年来收治的23例8个月～15岁的IE患儿进行回顾性分析。结果：23例IE患儿的基础病包括先天性心脏病14例(60．87％)，后天性心脏病3例(13．04％)。其它疾病6例(26．09％)。持续或反复发热(100％)、脾脏肿大(52．17％)、皮肤瘀点(47．83％)仍然是IE主要表现，栓塞(17．39％)较前减少，但并发心力衰竭较前增多(43．48％)。血培养阳性13例(56．52％)，其中金黄色葡萄球菌占46．15％。草绿色链球菌占30．77％，表皮葡萄球菌占23．08％。超声心动图发现赘生物13例(56．52％)。23例IE患儿治愈16例(69．57％)，死亡6例(26．09％)。结论：IE发生在先天性心脏病者仍居首位，临床表现多样化，致病菌中金黄色葡萄球菌仍占首位。超声心动图在诊断中有重要价值。预后与感染的细菌种类和毒力、以及并发症等有关。     

感染性心内膜炎52例临床分析

目的：探讨感染性心内膜炎的临床特征，旨在提高感染性心内膜炎诊治水平。方法：回顾性分析了52例感染性心内膜炎的基础病因、临床表现和并发症等。结果：感染性心内膜炎基础病因中风湿性心脏病比例为28．8％，比既往文献报道明显下降，而无基础心脏病比例23．1％，比既往文献报道明显升高。发热仍为感染性心内膜炎最常见症状及首发症状，其次为贫血(50％)及脏器栓塞(19.2％)，血培养阳性率为30．8％，其中主要是草绿色链球菌(31．3％)和表皮萄葡球菌(18．8％)。51.9％经胸心脏彩色超声心动图发现赘生物。住院期间死亡率为11．5％，死亡原因多为心力衰竭及脑栓塞。结论：感染性心内膜炎基础病因和致病菌发生了变化，心功能状态及有无脏器栓塞是决定其预后的主要因素。     

感染性心内膜炎104例临床分析

目的：探讨本组感染性心内膜炎病例的临床特点。方法：回顾性分析近10年来住院诊治的感染性心内膜炎(IE)的临床特点。结果：IE发病无明显年龄特点，基础心脏病中风心病较以往减少，先心病、原发性瓣膜脱垂及无心脏病增多。临床表现以发热、贫血、心衰最多见。超声心动图发现赘生物特异性最大，血培养阳性率降低。结论：IE临床表现复杂多样，但以发热、贫血、心衰最常见，结合心脏杂音，应予高度重视，避免漏诊。     

先天性心脏病并发感染性心内膜炎75例临床分析

目的探讨先天性心脏病并发感染性心内膜炎(IE)的临床特点．为其诊断与治疗提供参考。方法回顾性分析75例住院患中各类先天性心脏病IE的发生率、临床特点、血培养、心内膜受累和治疗情况。结果①先天性心脏病IE中主动脉瓣受累的发生率最高(11／11)；②手术证实累及多个瓣膜及病变多样；③尿检查改变、肝肿大和脾肿大的发生率及血培养阳性率下降，可能与抗生素广泛应用及开展侵袭性检查有关。本组血培养阳性率35．7％(20／50)．致病菌以草绿色链球菌为常见(14／25)；④手术治疗45例。治愈44例，死亡1例．其余内科治愈13例，因动脉栓塞或心功能恶化而自行出院14例，死亡3例。结论适当的内科治疗与积极的外科治疗相结合是治疗IE的重要手段，对提高存活率、降低病死率有重要意义。     

感染性心内膜炎43例临床分析

目的：分析我院近10年所收治的43例感染性心内膜炎(IE)的临床资料特点。方法：回顾分析43例IE的诊治经过，并将所得结果与1994年报道的1983～1993年的IE的相应资料进行比较。结果：43例中有心脏基础疾患者37例(其中先天性心脏病6例。风湿性心脏病16例，冠心病5例，老年退行性心瓣膜病3例，左房室瓣脱垂1例，既往有IE史者6例)。43例中人工瓣膜的心内膜炎(PVE)占27．9％(12／43)。发热为IE最常见的临床表现和首发症状。共42例(98．9％)，其次为贫血和心功能不全，分别为25例(占58．1％)和18例(41．9％)。超声心动图检查发现赘生物26例(62．8％)，自然瓣膜心内膜炎(NVE)和PVE的赘生物检出率没有统计学差别。赘生物好发部位依次为左房室瓣(16例)，主动脉瓣(7例)以及左房室瓣和主动脉瓣均受累(3例)。43例中细菌培养阳性率为48．8％(21／43)，其中，最常见的虽然仍是草绿色链球菌，共5例(11．6％)，但所占比例已明显下降。值得重视的是金黄色葡萄球菌、嗜麦芽窄食单胞菌及铜绿假单胞菌等引起的IE。结论：在抗生素治疗的基础上。探讨更有效的诊断和治疗方法，应该是目前针对IE的重点。     

超声心动图在诊断不合并先天性心脏病儿童感染性心内膜炎中的临床应用价值

目的 探讨超声心动图诊断不合并先天性心脏病(CHD)儿童感染性心内膜炎(IE)的临床应用价值。方法 回顾性分析住院确诊的不合并CHD儿童IE的临床及超声心动图特征。结果 共42例患儿纳入研究,其中男性24例,女性18例,平均年龄(7.09±4.27)岁。临床表现发热最常见。血培养阳性32例(76.2%),其中金黄色葡萄球菌22例。39例(92.9%)超声心动图提示赘生物,其中位于左心31例,右心7例,累及双心系统1例。赘生物多位于瓣膜,21例累及二尖瓣。37例患儿出现瓣膜反流,1例患儿出现瓣膜轻度狭窄。内科治疗后超声发现赘生物减小或消失16例。结论 超声心动图能够为不合并CHD儿童IE的早期诊断、临床治疗的效果监测提供重要的科学依据。     

亚急性感染性心内膜炎36例临床分析

目的 探讨亚急性感染性心内膜炎的基础病因、临床特征、治疗方法及预后,以提高对该病的诊治水平.方法 对36例亚急性感染性心内膜炎患者的基础心脏疾病、临床特点、致病菌、超声心动图、治疗方法、预后等进行回顾性分析.结果 本资料亚急性感染性心内膜炎的基础病因构成发生改变,风湿性心脏病所占比例下降,先天性心脏病及无基础心脏病所占比例升高;临床特征仍以发热、心力衰竭、中性粒细胞增加、红细胞沉降率增加、贫血常见;血培养阳性率58.33%,致病菌以草绿色链球菌多见.63.89%患者经胸超声心动图发现心脏有赘生物形成;本资料亚急性感染性心内膜炎的近期病死率是19.44%.结论 亚急性感染性心内膜炎的基础病因构成、临床特征、致病菌和以往比较发生改变,虽经积极治疗,病死率仍很高,对有手术适应证的患者应尽早手术治疗.     

感染性心内膜炎诊断与内科治疗进展

<正> 进入抗生素时代后感染性心内膜炎(infective en-docarditis,IE)的防治有明显进步,但其发病率及死亡率仍较高,近年来其临床表现与前有所不同,诊治方面有不少进展。一、IE病理基础的变化在抗生素应用之前,风心病是首位基础病变,其次是先天性心脏病,但如今风心病发病率已明显下降,先天性心脏病能得到早期治疗,故两者作为IE基础病变的比例下降。而由二尖瓣脱垂(mitral valveprolaps,MVP)、老年退行性心脏病、吸毒、心脏手术,人工心脏起搏器植入及心导管检查治疗等引起的IE增多。据国外一组病例报道、自身瓣膜IE病人中风     

超声心动图诊断感染性心内膜炎的意义

目的　探讨感染性心内膜炎 (IE)患者的超声心动图的特征性改变及诊断意义。方法　 17例IE患者进行了经胸超声心动图检查 ,探测赘生物的位置 ,大小 ,活动度及瓣膜功能。结果　男 11例 ,女 6例。平均年龄 3 4岁 (年龄范围 2～76岁 )。超声心动图检查发现 16例自身瓣膜和 1例人工瓣膜有赘生物形成 ,其中 7个二尖瓣 ,9个主动脉瓣和 1个三尖瓣上有赘生物。平均赘生物大小 0 .8cm (范围 0 .3～ 1.6cm)。血培养葡萄球菌 4例 ,链球菌 4例 ,类酵母菌 1例 ,血培养阳性率 5 3 %。住院期间 4例死亡 (2 3 % ) ,11例充血性心衰 (64 % ) ,6例体循环栓塞 (3 5 % ) ,4例接受了瓣膜置换术 (2 3 % )。结论　超声心动图检测IE声像图观察比较直观 ,尤其在血培养阴性的IE患者尤为有用。超声心动图能探测到瓣膜的赘生物 ,提示严重心衰 ,对于需要早期外科手术的IE患者提供重要依据     

Results of observation of infective endocarditis patients during 1965-2005

AIM: To clarify the trends in infective endocarditis by our experience for 40 years. MATERIAL AND METHODS: During the last 40 years (1965-2005) we observed 620 patients with infective endocarditis (IE). There were 615 patients with subacute IE (99.2%) and only 5 patients with acute IE (0.8%). There were 402 males (66.8%) and 218 females (35.2%). The age was 16-84 years (mean age 53 +/- 17). We studied the finding of hemoculture, echocardiography, immunological investigations, the levels of C-reactive protein. RESULTS: Streptococcal endocarditis runs a standard course, but more often we encountered staphylococcal, enterococcal endocarditis with a severe course. Predisposing cardiac disorders in 264 IE patients were rheumatic heart disease, congenital heart disease, mitral prolapse, involutive valve disease, hypertrophic cardiomyopathy, prosthetic valve. CONCLUSION: Conventional and unconventional IE cases, recurrent IE, current criteria of IE are described.     

The diagnostic ability of echocardiography for infective endocarditis and its associated complications

Echocardiography, transthoracic and transoesophageal, plays a key role in the diagnosis and prognosis assessment of patients with infective endocarditis. It constitutes a major Duke criterion and is pivotal in treatment guiding. Seven echocardiographic findings are major criteria in the diagnosis of infective endocarditis (IE) (vegetation, abscess, pseudoaneurysm, fistulae, new dehiscence of a prosthetic valve, perforation and valve aneurysm). Echocardiography must be performed as soon as endocarditis is suspected. Transoesophageal echocardiography should be done in most cases of left-sided endocarditis to better define the anatomic lesions and to rule out local complications. Transoesophageal echocardiography is not necessary in isolated right-sided native valve IE with good quality transthoracic examination and unequivocal echocardiographic findings. Echocardiography is a very useful tool to assess the prognosis of patients with IE at any time during the course of the disease. Echocardiographic predictors of poor outcome include presence of periannular complications, prosthetic dysfunction, low left ventricular ejection fraction, pulmonary hypertension and very large vegetations.     

感染性心内膜炎194例的临床和病原学特点

目的 分析血培养阳性的感染性心内膜炎(infective endocantitis,IE)患者的临床及病原学特点,为合理使用抗菌药物提供依据.方法 回顾性分析武汉亚洲心脏病医院2014年1月-2018年12月收治的194例血培养阳性的IE患者病历资料,包括年龄、性别、临床表现及病原学检查结果 等.结果 194例血培养阳...     

An unusual etiology of infective endocarditis: Enterobacter cloacae

Gram-negative microorganisms are rarely implicated in causing infective endocarditis (IE). Although the traditionally identified risk factor for Gram-negative endocarditis has been intravenous drug abuse, recent studies have revealed that healthcare contact and the presence of prosthetic cardiac devices are primary risk factors for IE secondary to non-HACEK Gram-negative bacteria. We present a case of Enterobacter endocarditis in a patient with no prior history of valvular heart disease, implanted endovascular device, or intravenous drug abuse. The patient was treated successfully with carbapenem monotherapy. We have reviewed 43 cases of Enterobacter endocarditis reported in the literature to date. Clinical summary and management of IE secondary to Enterobacter based on all the published cases is outlined.     

感染性心内膜炎伴心功能不全超声表现北大核心CSCD

目的观察感染性心内膜炎(IE)伴心功能不全超声表现及其诊断价值。方法回顾性收集98例IE伴心功能不全患者,根据纽约心脏协会(NYHA)分级将其分为NYHAⅡ级组(n=30)、NYHAⅢ级组(n=43)及NYHAⅣ级组(n=25);对比3组临床及超声资料,将组间差异有统计学意义的指标纳入logistic回归分析,观察各指标与IE伴心功能不全的关系。结果98例中,45例血培养阳性(45/98,45.92%),其中24例(24/45,53.33%)致病菌为甲型溶血性链球菌;67例(67/98,68.37%)合并心脏基础疾病,其中19例(19/67,28.36%)合并二叶主动脉瓣。经手术治疗后,77例症状减轻,NYHAⅢ级组8例、NYHAⅣ级组13例死亡。3组合并瓣膜反流、赘生物累及多个瓣膜及瓣叶穿孔病例占比差异均有统计学意义(P均<0.05),且重度瓣膜反流、赘生物累及多个瓣膜及瓣叶穿孔是评估IE伴心功能不全分级的独立预测因素(P均<0.05)。结论IE伴心功能不全超声心动图可表现为重度瓣膜反流、赘生物累及多个瓣膜和瓣叶穿孔;根据上述表现可预测其分级。     

Clinical features remain important for the diagnosis of infective endocarditis in the modern era

BACKGROUND: Infective endocarditis (IE) can be difficult to diagnose, due to multiple (often non-specific) presenting features. AIM: To assess the predictive accuracy of classical clinical features and blood investigations readily available at the time of presentation. DESIGN: Cross-sectional analysis. METHODS: We studied 29 IE cases and 79 controls (clinically suspicious contemporaneous cases where IE was subsequently excluded) from a hospital-based group of patients referred to a cardiac department with possible infective endocarditis. Patients were identified from the echocardiography database. Cases were defined by final diagnosis. Symptoms, signs, risk factors for IE and blood investigations were recorded from case notes and examined by univariate and multivariate analyses. RESULTS: The sensitivity, specificity, and positive and negative predictive values of transthoracic echocardiography (TTE) for detection of IE in clinically suspected cases were 71%, 98%, 57% and 99%, respectively. Univariate analyses revealed a significant association between IE and several clinical features. Under multivariate analysis, previous heart valve surgery (OR 13.3, 90%CI 3.2-55.6), positive blood cultures (OR 17.2, 90%CI 4.9-58.8), signs of embolism (OR 11.4, 90%CI 3.0-43.5), a new, altered or changing murmur (OR 10.3, 90%CI 2.8-38.5) and splenomegaly (OR 18.2, 90%CI 3.6-90.9) were independent predictors for IE. DISCUSSION: Clinical features at presentation continue to be important for the diagnosis of IE. Features such as positive blood cultures, signs of embolism and a changing heart murmur should be used to guide investigation and treatment of IE prior to echocardiography, or when TTE is negative.     

多模态成像诊断人工瓣膜感染性心内膜炎进展

人工瓣膜心内膜炎(PVE)是心脏瓣膜置换术后严重并发症，死亡率较高。超声心动图是首选影像学诊断PVE方法，但受人工瓣膜声影干扰，使其敏感度不能令人满意。近年来，包括心脏CT、核医学成像、心脏MRI在内的多模态成像技术与超声心动图相结合，提高了影像学诊断PVE的效能。本文就多模态成像诊断PVE进展进行综述。     

Approaches to late prognosis in patients with subacute infectious endocarditis

AIM: To ascertain late prognosis of subacute infectious endocarditis (IE), factors involved in the prognosis, formulate approaches to assessment of late prognosis. MATERIAL AND METHODS: A retrospective trial included 98 patients discharged from a hospital with diagnosis "subacute IE", treated without surgery or without endocarditis of the prosthesis. The diagnosis was verified at echocardiography. A mean follow-up 4.8 +/- 3.7 years. Clinical and echo-CG follow-up findings were computer-processed. RESULTS: 5-year lethality was 31%. The patients died of cardiac failure (CF) and acute failure of cerebral circulation (84 and 16%, respectively). Late complications in the survivors were the following: severe CF (18 patients, 32%), moderate CF (18 patients, 32%), recurrent IE (12 patients, 20%). Such factors as IE variant (primary or secondary), affection of the aortic valve, severity of regurgitation, size of the left ventricle, CF progression in the acute phase proved to have a significant influence on late prognosis. CONCLUSION: The prevalent cause of death in IE is CF. The progression of CF depends on combination of the above factors. High risk group patients should be examined by a cardio-surgeon even in the absence of clinical symptoms of CF.