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。     

The results of conservative therapy and the analysis of survival rate in drug addicted patients with infectious endocarditis

110 drug addicted patients with infectious endocarditis (IE), 67 males and 43 females with average age 24 +/- 3.2 years were examined. Positive results of conservative therapy were in 69.2% patients with isolated lesion of tricuspid valve. Hospital lethality in the group of patients was 35.5% (39 cases). The analysis of survival rate of IE patients with the use of Cox's regression model made possible to establish that main predictors of lethal outcome in the group of patients were dimensions of microbe vegetations on tricuspid valve more than 2 cm, development of acute left ventricle failure, DIC-syndrome, and high degree tricuspid valve failure. Presence of HIV in early stage and C hepatitis without clinical laboratory activity did not have significant influence on IE outcome in this group of patients.     

感染性心内膜炎38例临床分析

目的 探讨感染性心内膜炎（IE）的临床特点,诊断,治疗方法及转归.方法 回顾分析近17年38例感染性心内膜炎患者的临床特征及诊断.结果 ①38例患者中36例为自体心脏瓣膜心内膜炎,2例为人工瓣膜心内膜炎.36例自体瓣膜心内膜炎中,基础心脏病占72.22%（26/36）,其中风湿性心脏病占36.11%（13/36）,先天性心脏病占22.22%（8/36）,原发性二尖瓣脱垂占8.33%（3/36）,高血压性心脏病占2.78%（1/36）.心肌病占2.78%（1/36）.②38例患者临床表现包括发热100%（38/38）,寒颤57.89%（22/38）.贫血55.26%（21/38）.脾肿大50%（19/38）.脏器栓寒15.79%（6/38）.③血培养阳性率为31.58%（12/38）.其中8例为链球菌属,4例为葡萄球菌属.④38例患者中30例（78.94%）患者经单纯抗感染治疗后治愈,4例（11.1l%）患者经手术联合药物抗感染治疗后治愈,有4例（11.11%）合并心衰而死亡.⑤38例感染性心内膜炎患者中,无基础心脏病患者10例,有基础心脏病患者26例.10例无基础心脏病患者中有明确感染途径的占6例,26例有基础心脏病患者中有明确感染途径的占7例,两者感染途径阳性率比较差异有统计学意义（P=0.006）.结论 感染性心内膜炎最常见的基础心脏病是风湿性瓣膜病、先天性心脏病、二尖瓣脱垂;对于长期不明原因发热,应考虑有感染性心内膜炎的可能,有明确感染途径而长期发热者应高度怀疑感染性心内膜炎.超声心动图有助于感染性心内膜炎的诊断,血培养阳性率并不高.合并心力哀竭者则预后不良.     

葡萄球菌感染性心内膜炎46例临床分析

目的 探讨葡萄球菌感染性心内膜炎(IE)患者的临床和病原学特征,为临床诊治提供依据.方法 对北京协和医院2011年至2018年住院治疗的46例葡萄球菌IE患者进行回顾性分析.结果 本组46例葡萄球菌IE,占同期诊断的425例IE总数的10.8％.发热(97.8％)是最常见的临床表现,其次是贫血(73.3％)和心脏杂音(...     

急性肾功能衰竭96例临床研究

目的研究急性肾功能衰竭(ARF)患者的病因、预后和影响预后的因素。方法回顾性研究我院2004年6月至2008年6月住院ARF患者的临床资料。结果观察期间住院患者共34 622例次,其中ARF患者96例,占同期住院患者的0.28%。ARF主要病因为感染、心力衰竭和药物。ARF患者病死率为30.2%,进行肾替代治疗者病死率(24.1%)低于保守治疗者(35.8%),二者比较差异有统计学意义(P0.01)。结论住院ARF患者的主要病因是感染、心力衰竭和药物,ARF的发病率和病死率较高,肾替代治疗预后较好。     

感染性心内膜炎的临床变迁（附116例临床分析）

目的 探讨感染性心内膜炎(IE)的病因、致病微生物的变化、临床变迁及预后等因素，提高IE的诊治水平。方法 对1990年6月-2002年6月住院的116例IE患基础心脏病情况、主要临床表现、血培养、超声心动图检查、治疗结果及预后等进行分析。结果 IE基础心脏病中，先天性心脏病的比例(34．5％)有所升高，而风湿性心脏病的比例(25．9％)有所下降，无器质性心脏病的比例(19．O％)较既往国内外报道的发病率有明显的提高。血培养阳性率为41．4％，草绿色链球菌是IE的主要致病菌(29．2％)；近年来，发现条件致病菌假单胞菌属引起IE(本组4例)。超声心动图探测心内赘生物的比例为65．5％。人工瓣膜性IE发病率(17．2％)有所升高，死亡率为25．O％。本组死亡13例(11．2％)，本病预后严重。结论 IE基础心脏病和致病菌发生较明显变化，超声心动图对IE诊断及治疗有重要价值，本病预后严重，人工瓣膜性IE发病率及死亡率高，应尽早手术治疗。     

活动期感染性心内膜炎手术时机的分析

目的 探讨活动期感染性心内膜炎(infectiue endocarditis,IE)患者心脏手术的最佳时期.方法 回顾分析1999年9月-2009年9月行外科治疗的92例IE患者的临床资料.IE诊断标准为修订的Duke标准.采用SPSS 12.0软件包,分析了年龄、性别、是否是院内感染IE、合并症(糖尿病、慢性阻塞性肿...     

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。     

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.     

Infective endocarditis in the Western Cape Province of South Africa: a three-year prospective study

BACKGROUND: The last 50 years have seen major changes in the epidemiology of infective endocarditis (IE). AIM: To evaluate local patient characteristics, risk factors, clinical sequelae, microbiology, morbidity and mortality in patients with definite IE. DESIGN: Prospective observational study. METHODS: Over a three-year period, patients referred with probable IE were prospectively enrolled. All received a standardized diagnostic evaluation. Epidemiological data were documented; underlying risk factors for IE were sought. Initial evaluation and follow-up (to 6 months) included the documentation of vascular or immunological phenomena, morbidity and mortality. RESULTS: Of 92 patients referred with probable IE, 47 had definite IE. These patients had a mean age of 37.7 years with a male predominance (1.6:1). Rheumatic heart disease was present in 36 (76.6%). Eight had prosthetic valves. Three had congenital heart disease, mitral valve prolapse or multiple central intravascular catheters, respectively. All denied the use of intravenous recreational drugs and only one tested seropositive for HIV. Renal involvement (59.6%) and clubbing (29.8%) were commonly observed. The 6-month mortality rate was 35.6%, while 44.7% needed valvular replacement. An aetiological diagnosis was made in 21, with viridans streptococci the most common isolate. DISCUSSION: Infective endocarditis in the Western Cape of South Africa is a disease of younger adults, with a male predominance. Rheumatic heart disease is the major predisposing factor. Degenerative heart disease and intravenous drug abuse are not important risk factors. Our data do not support the notion that HIV infection is an independent risk factor for IE. Local mortality rates are much higher than recent international figures, as is the proportion of 'culture-negative' IE.     

老年人糖尿病合并急性心肌梗死的临床特点分析与护理对策

目的分析老年人糖尿病合并急性心肌梗死 (AMI)的临床特点 ,以探讨护理对策。方法对老年糖尿病合并AMI患者 86例 (糖尿病组 ) ,非糖尿病AMI1 2 0例 (对照组 ) ,观察其临床症状、主要并发症及预后。结果糖尿病组非典型胸痛、意识障碍、呼吸困难、胃肠道反应发生率显著高于对照组 (P <0 0 1、P <0 0 5 ) ,心力衰竭及住院病死率显著高于对照组 (P <0 0 1 ) ,死亡原因主要是心力衰竭。结论老年人糖尿病合并AMI的患者临床症状不典型 ,并发症及病死率高 ,护理人员应高度警惕。     

Correction of secondary immunodeficiency as a method of prevention of suppurative-septic complications after surgery with artificial blood circulation

Eighty-five patients with acquired heart diseases with and without infective endocarditis (IE) were examined. In one group of patients traditional therapy was supplemented by the Russian drug immunofan, a synthetic hexapeptide with immunomodulating, antiinflammatory, and detoxifying effects. A course consisted of 10 intramuscular injections every other day (1 ml of 0.005% solution). The drug was prescribed after immunological studies on a laser flow cytometer (Becton Dickinson, USA). Correction was carried out before and after the operation. The postoperative period was uneventful in patients treated with immunofan; the incidence of clinical manifestations of IE was decreased. The concentrations of cytokines (IL-1, IL-6, TNF-alpha) in the blood were increased in patients with IE. In patients treated with immunofan, the concentrations of cytokines were decreased and immune parameters were normalized. Changes in the cytokine status can be used as a laboratory test for evaluating the efficiency of treatment in cardiosurgical patients with IE.     

Effectiveness of combined treatment of infective endocarditis

The purpose of the study was to develop and perfect complex therapy of modern infective endocarditis (IE). Ten-year experience in clinical diagnostics of 240 patients with acute, subacute, and lingering IE was summarized; the effectiveness of their treatment was evaluated. The features of modern IE were acute and subacute course of the disease with the involvement of aortal (37.8% of cases), tricuspid (16.8%), mitral (15.2%) valve, and septicemia, caused by highly virulent microflora (staphylococci--51% of cases; gram-negative bacteria--13%; fungi--5%). The clinical manifestations of modern IE included toxic infectious syndrome (24% of cases), heart failure (21%), symptoms of complications (16%), central hemodynamics disturbances (12%), and splenomegaly (8%). The treatment included antibacterial, pathogenetic, and symptomatic therapy, as well as extracorporal hemocorrection and cardiosurgery. Analysis of the results of surgical treatment of 140 IE patients allowed development of indications for valve prosthesis.     

老年退行性心脏瓣膜病合并心力衰竭的临床研究

目的 研究老年退行性心脏瓣膜病合并心力衰竭发病的临床特征.方法 将40例合并心力衰竭的老年退行性心脏瓣膜病与同期收治的40例年龄、性别相匹配的、无瓣膜钙化的合并心力衰竭的冠心病患者进行临床对比研究.结果 退行性心脏瓣膜病组在心律失常、充血性心力衰竭的分级及心脏扩大均明显高于冠心病组（P＜0.01）.近期死亡率的发生率略高于对照组,但无统计学意义.结论 老年退行性心脏瓣膜病可导致血液动力学障碍,加重心功能损害,成为老年人充血性心力衰竭、猝死的重要原因之一.     

Is thrombolytic therapy effective for pulmonary embolism?

Pulmonary embolism is a disorder that is associated with significant morbidity and mortality. Right-sided heart failure and recurrent pulmonary embolism are the main causes of death associated with pulmonary embolism in the first two weeks after the embolic event. Thrombolysis is a potentially lifesaving therapy when used in conjunction with standard anticoagulation. However, it has significant side effects and must therefore be used with caution. Indications for thrombolysis are not well defined and are thus controversial. The only current absolute indication is massive pulmonary embolism with hypotension. Other potential indications include right heart dysfunction, recurrent pulmonary embolism and the prevention of pulmonary hypertension. However, no evidence exists to show benefit of thrombolytic therapy over standard anticoagulation therapy for recurrent pulmonary embolism, mortality or chronic complications. Bleeding is the most common complication of thrombolysis and may be fatal.     

扩张型心肌病药物治疗的护理体会

目的探讨扩张型心肌病药物治疗的临床护理方法。方法对29例患者采取有针对性的药物治疗护理,严密观察病情,指导出院用药。结果 29例患者经过治疗护理,27例症状缓解,1例栓塞,1例死亡。结论规范的药物治疗和有效的护理能控制心衰、延长存活时间。     

脑钠肽和D-二聚体检测对急性肺栓塞早期诊断及预后评估的价值

目的应用脑钠肽和D-二聚体的检测方法,以期达到对急性肺栓塞的早期诊断及预后判断。方法26例急性肺栓塞患者分为两组：观察组12例,给予脑钠肽、D-二聚体检查,确诊为肺栓塞后给予溶栓、抗凝治疗。对照组14例,给予心电图、胸片、心超、血气分析检查及外院肺通气灌注扫描检查,确诊为肺栓塞后给予溶栓、抗凝治疗;比较两组患者的确诊时间、病死率。结果观察组的确诊时间（14．1±1．8h）和病死率（25．0％）显著低于对照组（23．3±1．5h、35．7％）,差异均具有显著性（P〈0．05）。结论联合应用脑钠肽和D-二聚体的检测方法对急性肺栓塞患者能够有效的缩短确诊时间、改善临床症状、降低死亡率。     

The course of infectious endocarditis in IV drug abusers and in subjects predisposed to heart diseases

40 patients with infective endocarditis (IE) abusing intravenous drugs (heroin, opium surrogates) and 9 IE patients predisposed to heart diseases were examined by Duke diagnostic criteria. IE in drug abusers is characterized by acute course of the disease with affection of the intact valves of the right heart (97.5%) and septicemia provoked by high-virulent microflora (Staph. aureus in 65%). Drug abusers showed the following principal clinical syndromes of IE: thromboembolic (65%); septic with formation of acute DIC syndrome (75%), development of pyodestructive foci in the organs and polyorganic insufficiency (23.3%); acute circulatory insufficiency (37.5%); secondary nephropathy (100%). In IE abusers with predisposition to heart diseases IE ran subacutely in the presence of bacteriemia caused by low-virulent microflora (Strept. viridans in 11%) or in the absence of microbial growth in blood seeding (78%). High IE lethality in drug abusers (40%) is explained both by severe complications and concomitant diseases (viral hepatitis B and C, HIV infection, etc.).     

感染性心内膜炎近10年临床特点变迁

目的通过对感染性心内膜炎（IE）患者临床特点分析，探讨IE临床特点的变迁及合理治疗情况。方法对1997年1月至2006年12月收治的207例IE患者的临床特点进行回顾性分析，按住院时间分为Ⅰ组130例（1997年1月至2001年12月）及Ⅱ组77例（2002年1月至2006年12月）。结果Ⅱ组患者与Ⅰ组比较病史增加，住院时间缩短；血细菌阳性率降低，链球菌的比例由52．17％下降到33．33％，而金葡菌由15．94％上升到23．33％；发热、镜下血尿的发生率明显降低，贫血等临床表现则明显增多；患者死亡率由27．69％下降到16．88％，死亡原因仍以心衰为主。结论在过去的10年，感染性心内膜炎患者临床特点有着明显的变化，要引起特别注意。     

Diastolic dysfunction

Although the annual mortality rate for diastolic heart failure is better than that for systolic heart failure, it is still greater than that for age-matched controls. Five-year mortality rates are about 50% for patients with systolic heart failure and are about 25% for patients with diastolic heart failure. In elderly patients (over 65 years of age), the outcome with systolic and diastolic dysfunction may be more comparable. In contrast to systolic heart failure, the effect of therapy in patients with diastolic heart failure has not been evaluated in large clinical controlled trials. Guidelines for managing heart failure with preserved systolic function broadly suggest the direction for management, but specific treatments are currently based on expert consensus, clinical experience, and scientific elucidation of diastolic mechanics. Although evidence-based guidelines are not available for all aspects of management of diastolic heart failure, future research will increase the knowledge of this disorder and improve treatment strategies.