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。

Clinical vicissitudes of infective endocarditis

Objective To investigate causes, change of pathogenic microorganism, clinical vicissitudes and prognosis in infective endocarditis (IE) to improve the diagnosis and treatment of IE. Methods 116 patients with IE (from June of 1990 to June of 2002) were analysed on their cardiac disease background, main clinical situation, blood cultivation, echocardiography, treatment effect and prognosis. Results The disease background included congenital heart disease(34.5%)( the proportion of which had been stepping up) and rheumatic heart disease(25.9%) (the proportion of which were descent). The proportion of no cardiac disease cases were obvious higher than that reported(19.0%). Positive blood cultivation was found in 48(41.4%)cases. Streptococcus viridans was the main pathogenic bacteria (29.2%). Stenotrophomonas maltophilia has been discovered in 4(8.3%)cases of IE recently. Endocardial vegetation was found in 76(65.5%)cases by echocardiography. Prosthetic valve endocarditis (PVE) was found in 20(17.2%)cases. The death rate of PVE was 25.0%. 13 cases died in all these 116 cases of IE. The prognosis of IE was not satisfactory. Conclusion There are remarkable changes in predisposing diseases and pathogenic bacteria in IE. echocardiography has important value to diagnosis and treatment of IE. Prognosis of IE is serious. PVE has a higher incidence and mortality and should be operated as early as possible.