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.

Clinical Analysis of 38 Patients of Infective Endocarditis(IE)

Objective To investigate the clinical characteristics,diagnosis,therapeutical approaches and outcome of infective endocarditis（IE）. Methods The clinical features and diagnosis of 38 IE patients treated in our hospital in recent 17 years were analyzed retrospectively. Results ①Among 38 IE patients,there were 36 cases of native valve endocarditis and 2 cases of prosthetic valve endocarditis.72.22%（26/36）of native valve endocarditis patients had underlying heart diseases including 36.11%（13/36）of rheumatic heart disease,22.22%（8/36）of congenital heart diseases,8.33%（3/36）of idiopathic mltral valve prolapse,2.78%（1/36） of high pressure heart diseases,2.78%（l/36） of cardiomyopathy.②The main clinical manifestations included fever （100%,38/38）,anemia（55.26%,21/38）,splenomegaly（50%,19/38） and embolism（15.79%,6/38）.③Positive rate of blood culture 31.58%（12/38）.8 cases were Streptococcus.4 cases were Staphylococcus.④Prognosis：30 cases（78.94%） were cured by simple antimicrobial therapy.4 cases（l 1.11%） were cured by the combination of antibiotics and surgel2~.4 cases（l 1.11%） died by heart failure.⑤Among 38 IE patients,26 had underlying heart disease and 10 had not.However, definite infective approach was only 26.92%（7/26）in the IE patients with underlying heart disease,and 60%（6/10）had obvious infection approach.Those had significant difference（P=0.04）. Conclusions Three most common heart diseases predisposing to IE were rheumatic heart disease,congenital heart diseases and idiopathic mitral valve prolapse.For the patients with long-term fever of unknown reason,especiallythose without underlying heart diseases but with obvious infective approach,IE should be highly suspected.The findings by echocardiography were important to IE diagnosis.Positive rate of blood culture is not too high.