215例感染性心内膜炎临床分析

目的探讨感染性心内膜炎的临床特征,提高感染性心内膜炎的诊治水平.方法回顾性分析了215例感染性心内膜炎的基础病因、临床表现及并发症等.结果感染性心内膜炎基础病因中风湿性心脏病比例(30.2%)有所下降,而先天性心脏病比例(34.9%)相对升高,无基础心脏病比例(16.7%)比以往报道明显增加.发热(占87.9%)为感染性心内膜炎常见临床表现及首发症状,其次是贫血(61.9%)及脏器栓塞(21.9%).血培养阳性率为57.7%,其中主要致病菌是草绿色链球菌(32.4%)和表皮葡萄球菌(15.5%).134例(62.3%)超声心动图检查发现赘生物.17例早期人工瓣膜心内膜炎有8例死亡,占47.1%.住院期间死亡率为10.6%,死亡原因主要是心力衰竭和脑血管意外.结论感染性心内膜炎基础病因和致病菌发生较明显变化,早期人工瓣膜心内膜炎死亡率高,应尽早手术治疗.

Clinical Analysis of 215 Cases of Infective Endocarditis

Objective: To improve the diagnosis and treatment of infective endocarditis (IE)by analysing their clinical features. Methods: The underlying disease, clinical features and complication of IE were analyzed retrospectively in 215 patients. Results: The underlying diseases included the rheumatic heart disease (30.2% )and congenital heart diseases (34.9% ). No underlying disease in 36 (16.7%). Fever was the most common and initial symptom (87.9%). Others were anemia (61 .9% )and peripheral vascular embolism (21 .9% ). Positive blood culture was found in 71 patients (57.7% ) of viridans streptococci (32.4% ), staphylococcus epidermidis (15.5% ). Endocardial vegetation was foun in 134 (62.3% ) patients by transthoracic echocardiography. Eight of the 17 patients with early prosthetic valve endocarditis (PVE)died. The major lethal cause was chronic congestive heart failure and cerebrovascular stroke. Conclusion: There are remarkable changes in predisposing diseases and microorganisms. Early PVE has a higher mortality and should be operated for promptly.