血培养阴性感染性心内膜炎的临床特点

 目的 探讨血培养阴性感染性心内膜炎的临床特点及手术治疗效果。方法 收集某院心胸外科2014年1月—2021年12月经手术治疗的感染性心内膜炎患者的临床资料,按血培养病原学结果分为阳性组、阴性组,回顾性分析两组患者的临床特点及外科手术效果。结果 共有88例感染性心内膜炎患者,血培养阴性61例(阴性组),阳性27例(阳性组),阳性率为30.7%。83例患者术前超声心动图有阳性发现,包括赘生物、瓣膜毁损、人工瓣瓣周漏、脓肿、腱索断裂等,所有患者均经外科手术治疗。阴性组患者发热的比率较阳性组低(36.1% VS 81.5%),胸闷气促的比率较阳性组高(80.3% VS 74.1%),差异均有统计学意义(均P＜0.05)。61例阴性组患者的基础心脏病以合并主动脉瓣二叶畸形为主(16.4%);累及主动脉瓣(37例)、二尖瓣(20例)、三尖瓣(2例),2例同时累及主动脉和二尖瓣;阴性组患者瓣膜毁损(78.7% VS 63.0%)和腱索断裂(47.5% VS 22.2%)比率较阳性组高,差异均有统计学意义(均P＜0.05)。两组患者均以心功能不全及栓塞为主要并发症,心功能不全者阴性组18例,发生率29.5%,阳性组7例,发生率25.9%。阴性组患者病死率为8.2%,阳性组为7.4%,两组比较差异无统计学意义(P＞0.05)。结论 早期诊断、早期规范治疗,选择合适的手术时机和方案,以及加强围手术期管理,血培养阴性感染性心内膜炎患者可取得较好的治疗效果。

Clinical characteristics of blood culture-negative infective endocarditis

Objective To evaluate the clinical characteristics and surgical treatment effectiveness of blood culture-negative infective endocarditis (IE).Methods Clinical data of patients with IE who underwent surgical treatment in department of cardiothoracic surgery of a hospital from January 2014 to December 2021 were collected, patients were divided into positive group and negative group according to the results of blood culture pathogen, clinical chara-cteristics and surgical treatment effectiveness of two groups of patients were analyzed retrospectively.Results A total of 88 patients were with IE, 61 of whom were negative for blood culture (negative group) and 27 were positive for blood culture (positive group), with a positive rate of 30.7%. 83 patients were found positive by echocardiography before operation, including vegetations, valve damage, perivalvular leakage of artificial valve, abscess, rupture of chordae tendineae, etc, all patients were treated by surgery. The ratio of fever in negative group was lower than that in positive group (36.1% vs 81.5%), the ratio of chest tightness and shortness of breath was higher than that in positive group (80.3% vs 74.1%), difference was significant (all P<0.05). In 61 patients in negative group, the primary heart disease was mainly associated with bicuspid aortic valve malformation (16.4%); involving aortic valve (n=37), mitral valve (n=20) and tricuspid valve (n=2), 2 cases involving both aortic valve and mitral valve, proportion of valve deterioration and rupture of chordae tendineae were both higher than positive group (78.7% vs 63.0%, 47.5% vs 22.2%), difference were both significant (both P<0.05). The main complications of both groups of patients were cardiac insufficiency and embolism; 18 patients with cardiac insufficiency were in negative blood culture group,incidence was 29.5%, and 7 patients were in positive blood culture group, incidence was 25.9%. Mortality of patients in negative group and positive group were 8.2% and 7.4% respectively, there was no significant difference between two groups (P>0.05).Conclusion Early diagnosis, early standardized treatment, selection of appropriate surgical opportunity and scheme, and strengthening perioperative management can achieve better therapeutic effect for IE patients with negative blood culture.