先天性心脏病合并感染性心内膜炎的临床特征及病死影响因素

目的分析先心病(CHD)合并感染性心内膜炎(IE)患者的临床特征及病死相关因素,为临床工作提供依据。方法选取2017年1月-2019年1月川北医学院附属医院的102例CHD合并IE患者作为研究对象,通过查阅病历对其临床特征、病死情况及相关因素进行回顾性分析。结果患者症状和体征以咳嗽、气促、发热、心脏杂音、肝肿大为主,感染部位以左心为主,CHD类型以室间隔缺损、室间隔缺损合并房间隔缺损为主,大部分患者超声心动图检查可检出瓣膜赘生物。共有63例患者的血培养阳性,阳性率为61.76%,检出病原菌63株,其中,革兰阳性菌44株占69.84%,以金黄色葡萄球菌、毗邻颗粒链球菌、缓症链球菌为主;革兰阴性菌14株占22.22%,以大肠埃希菌为主;真菌5株占7.94%,以白假丝酵母为主。住院期间病死12例,病死率为11.76%;Logistic多元回归分析结果显示,CHD合并IE患者病死,其中合并动脉栓塞为危险因素,入院时血红蛋白水平较高为保护因素(P<0.05)。结论CHD合并IE患者的临床表现多样、合并疾病复杂,其病死风险与营养水平、合并疾病及治疗方法有关,临床医生应努力提高诊断和治疗效率,从而改善患者的预后。

Clinical characteristics of congenital heart disease patients complicated with infective endocarditis and influencing factors for death

OBJECTIVE To analyze the clinical characteristics of the congenital heart disease(CHD)patients complicated with infective endocarditis(IE)and observe the related factors for death so as to provide guidance for clinical treatment.METHODS A total of 102 CHD patients complicated with IE who were treated in the Affiliated Hospital of North Sichuan Medical College from Jan 2017 to Jan 2019 were recruited as the study subjects.The clinical characteristics,mortality rates and related factors for death were retrospectively analyzed by review of medical records.RESULTS Cough,shortness of breath,fever,heart murmur and hepatomegaly were the major symptoms and body signs;ventricular septal defect and ventricular septal defect complicated with atrial septal defect were the predominant types of CHD,the echocardiography of most of the patients showed valve vegetation.Totally 63 patients were positive for blood culture;totally 63 strains of pathogens were isolated,44(69.84%)of which were gram-positive bacteria,14(22.22%)were gram-negative bacteria,and 5(7.94%)were fungi;Staphylococcus aureus,Granulicatella adiacens and Streptococcus mitis were dominant among the gram-positive bacteria;Escherichia coli was the predominant species of gram-negative bacteria;Candida albicans was dominant among the fungi.Totally 12 patients died during the duration of hospital stay,with the mortality rate 11.76%.Multivariate logistic regression analysis showed that the arterial embolism was the risk factor for the mortnlity,and the high level of hemoglobin at the admission was the protective factor(P<0.05).CONCLUSION The CHD patients complicated with IE show diverse clinical manifestations and complex complications,the risk of death is associated with the nutrition status,complication with diseases and treatment measure.It is necessary for clinicians to make great efforts to raise the effective rates of diagnosis and treatment so as to improve the prognosis of the patients.