先天性心脏病合并感染性心内膜炎的临床及预后分析

目的总结分流型先天性心脏病合并感染性心内膜炎(IE)患者的临床特点、治疗及影响预后的因素。方法分析我院2001年1月-2010年12月收治的51例分流型先天性心脏病合并IE患者的临床资料。结果合并于分流型先天性心脏病的IE占全部IE患者的20.6%,其中室间隔缺损和动脉导管未闭是最常见的先天性心脏病。链球菌属(47.1%)是最常见的致病菌。52.9%的患者出现并发症,主要为瓣膜受损和系统性栓塞。38例患者(58.8%)行手术治疗,其中21例于IE活动期行早期手术。先心病合并IE的死亡率为19.6%。回归分析显示,严重心力衰竭(P<0.05)和神经系统并发症(P<0.05)是死亡率的预测因子,而手术治疗是死亡率降低的独立预测因子(P<0.05)。结论先天性心脏病合并IE者死亡率较高。出现严重心力衰竭和中枢神经系统并发症提示预后不良,手术治疗可显著降低死亡率。

Clinical characteristics and outcome of infective endocarditis in patients with congenital heart disease

Objective To summarize the clinical characteristics and management of infective endocarditis(IE) in patients with congenital heart disease and to identify the predictors of outcome.Methods From January 2001 to December 2010,51 adult patients with congenital heart disease and IE were studied.Results 20.6% IE patients were diagnosed as shunt congenital heart disease.Ventricular septal defect(VSD) and patent ductus arteriosus(PDA) were the most common underlying defects.Streptococci were the most common causative organisms(47.1%).52.9% patients had complications.The frequent complications were valve destruction and embolic events.38 patients(58.8%) performed cardiac surgery.Surgerys were performed during the active phase of infective endocarditis in 21 cases.The overall mortality rate was 19.6%.Logistic regression analysis identified presence of severe heart failure(P<0.05) and central nervous system complications(P<0.05) as predictors of mortality.Surgical intervention was independently associated with lower mortality(P<0.05).Conclusions The mortality of IE in patients with congenital heart disease was high.Presence of severe heart failure and central nervous system complication were independently predictive of mortality.Surgical intervention decreases the risk of mortality.