超声在感染性心内膜炎换瓣术前的诊断价值

目的 探讨经胸超声心动图(TTE)及经食道超声心动图(TEE)在感染性心内膜炎换瓣术前的诊断价值,为感染性心内膜炎换瓣术前的诊断提供参考.方法 共纳入85例来医院的可疑严重感染性心内膜炎需行换瓣术治疗的患者,入院时均详细记录患者的相关病史,并行TTE及TEE检查,以最终赘生物直接的组织病理学和微生物分析确诊为金标准,评价两者对感染性心内膜炎的诊断价值.结果 TTE对感染性心内膜炎的诊断价值结果显示,敏感度为68.0％,特异度为68.6％,阳性似然比为0.76,阴性似然比0.60;TEE对感染性心内膜炎的诊断价值结果显示:敏感度为90.0％,特异度为85.7％,阳性似然比为0.90,阴性似然比0.86.结论 感染性心内膜炎换瓣术前行TEE有重要的临床诊断价值,与TTE相比,TEE的诊断敏感度及特异度更高,可以更好地应用于临床.     

Prosthetic valve endocarditis

Prosthetic valve endocarditis occurs in 2-4% of patients with prosthetic valves and carries a mortality of around 50%. A low index of suspicion should enable early diagnosis. The empirical use of antibiotics in patients with a prosthetic valve who develop an unexplained fever is inappropriate. Careful liaison between cardiologist, microbiologist and cardiac surgeon is essential for optimal management.     

Prognosis of infectious endocarditis

OBJECTIVE: To study clinical course and prognostic factors of infective endocarditis. PATIENT AND METHODS: Infective endocarditis was identified in 126 consecutive patients (criteria of DURACK). Of these, 73 were male, mean age was 29.9 + 15 years, 98 (77.7%) had past history of cardiac disease. The evolution has been marked by 38 deaths (30%) in spite of the recourse to surgery (69 patients). The mean follow-up period was 52 months, the event-free survival was 61% at 5 years. RESULTS: By univariate analysis the predictors of bad prognosis: Large vegetations > 10 mm, delay of apyrexia > 10 days presence of a neurological accident and the absence of surgical treatment. Multivariate analysis: Vegetation > 10 mm (OR 1.97, 1-4.1, p = 0.05), presence of a neurological accident (OR:2.76, 1.32-5.76, p = 0.007) and the absence of surgical treatment (OR: 5.03, 2-11.4, p < 0.001). CONCLUSION: Infective endocarditis remains a serious affection, identification of patients with poor prognosis should lead to early surgical referral: this attitude provides good immediate and long-term results.     

主动脉瓣畸形患者感染心内膜炎病原菌分布及耐药性监测

目的 探讨主动脉畸形患者感染心内膜炎的病原菌分布特点及其耐药性,对临床治疗进行指导.方法 选取二叶式主动脉瓣畸形感染心内膜炎患者153例,对其临床资料进行回顾性分析,并行病原菌分离和耐药性分析.结果 153例患者共检出病原菌161株,其中革兰阳性菌123株,占76.40％,革兰阴性菌30株,占18.63％,真菌8株,占4.97％,排名前5位病原菌依次为酿脓链球菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌,分别占37.27％、24.22％、13.04％、9.32％、3.73％;酿脓链球菌、凝固酶阴性葡萄球菌及金黄色葡萄球菌对利奈唑胺、万古霉素和替考拉宁的耐药率均为0,酿脓链球菌对青霉素、头孢曲松、头孢噻肟以及左氧氟沙星的耐药性相对较低＜7.00％,而对克林霉素和红霉素的耐药性相对较高＞50.00％;凝固酶阴性葡萄球菌仅对利福平较为敏感,耐药率＜6.00％,而对青霉素类药物、头孢类药物和红霉素均表现出了很高的耐药性,耐药率＞80.00％;金黄色葡萄球菌除对青霉素耐药性特别高以外,对其他药物的耐药率均＜30.00％,其中对头孢唑林、头孢呋辛、庆大霉素以及利福平的耐药性＜10.00％.结论 二叶式主动脉瓣畸形感染心内膜炎患者病原菌存在多样性,在治疗的早期可根据经验给予联合用药治疗,并根据细菌培养和药敏试验结果随时对药物进行调整.     

肠球菌属感染性心内膜炎的临床分析

目的探讨肠球菌属感染性心内膜炎的临床特点,以提高治愈率。方法回顾性分析2005年1月-2013年1月医院收治的23例肠球菌属感染性心内膜炎患者临床资料,调查患者患病前心脏状况及其该次发病的临床表现,采用仪器法相配套的药敏卡进行药物敏感试验。结果 23例肠球菌属感染心内膜炎患者最常见临床表现为发热91.3%、贫血73.91%、新发心脏杂音73.91%、心力衰竭47.83%,发病至确诊时间为(57.2±14.3)d;共分离出20株粪肠球菌、2株屎肠球菌、1株坚忍肠球菌,分别占86.96%、8.69%、4.35%;粪肠球菌对青霉素和氨苄西林耐药率较低,分别为0和4.35%,屎肠球菌对青霉素和氨苄西林耐药率较高,分别为100.00%和50.00%;13例手术治疗患者治愈率达100.00%,10例非手术患者治愈率为50.00%。结论肠球菌属感染心内膜炎亚急性起病,发病至确诊时间长,在治疗早期可以根据经验选择氨苄西林联合氨基糖苷类或万古霉素,抗感染仍应遵循足疗程、大剂量;手术治疗组治愈率明显高于非手术组。     

Delayed diagnosis of infectious endocarditis]

Three cases are presented to show examples of mistakes in the diagnosis and treatment of infective endocarditis which led to serious complications. The role of echocardiography in the early diagnosis and in the recognition of complications, the importance of bacteriologic diagnosis in the choice of antibiotic treatment and the need of timely surgical treatment are emphasized.     

感染性心内膜炎合并血管栓塞的临床研究

目的 探讨感染性心内膜炎合并血管栓塞的临床特点,并分析其发生的相关危险因素,为其临床防治提供依据.方法 回顾性分析心内科120例感染性心内膜炎住院患者,采用统一的调查表详细记录其病史及相关信息,根据其是否并发血管栓塞分为栓塞组与未栓塞组,应用多因素回归分析进行多因素分析.结果 120例感染性心内膜炎患者有20例合并血管栓塞,发生率为16.7％,其中14例患者存在赘生物;感染性心内膜炎合并血管栓塞患者患高血压15例占75.0％、糖尿病14例占70.0％、血培养阳性14例占70.0％、赘生物培养阳性14例占70.0％,赘生物≥10 mm 10例占50.0％;未并发血管栓塞组患者高血压50例占50.0％,糖尿病50例占50.0％、血培养阳性45例占45.0％、赘生物培养阳性40例占40.0％,赘生物≥10 mm 25例占25.0％;两组间差异有统计学意义(P＜0.05);进一步多因素分析显示,赘生物培养阳性及赘生物直径≥10 mm为感染性心内膜炎合并血管栓塞发生的独立危险因素.结论 感染性心内膜炎亦并发血管栓塞的发生,赘生物培养阳性及赘生物直径≥10 mm为感染性心内膜炎合并血管栓塞发生的独立危险因素,因此在感染活动期应积极控制感染,能更好地预防栓塞的发生.     

Echo-Doppler features of pulmonary valve endocarditis

Three patients with fever and pneumonitis were found to have pulmonary valve vegetations by echocardiography. Pulsed and color flow Doppler studies demonstrated mild to moderate pulmonary valve insufficiency in these patients. All patients responded to the appropriate antibiotics without requiring valve surgery. Echocardiography is of value in diagnosing pulmonary valve endocarditis and should be considered in every patient with recurrent pneumonitis.     

Aortic valve replacement in the elderly

We report a retrospective study about 60 patients operated on for aortic valve replacement between 1981 and 2000. All patients were aged more than 65 years. 56.6% of patients were in the class III or IV of the NYHA. The type of the valvular substitute was a mechanical prostheses in 58.3% of cases and a biological prostheses in 41.7%. A mitral geste was associated in 6 cases and a myocardial revascularisatin in 5 cases. The early mortality rate was 15% and the late mortality was 23%. The high mortality is meanly related to the associate lesions (coronaropathy) and the prognosis is a better with the improvement of surgical technics and perioperative management.     

Prosthetic valve endocarditis caused by Bartonella quintana

We describe the first case of Bartonella quintana endocarditis affecting a prosthetic valve in a person with no known risk factors for this infection. Bartonella should be considered as a cause of endocarditis in any clinical setting.