感染性心内膜炎70例临床分析

目的 探讨感染性心内膜炎(IE)的临床特点、治疗方法及转归。方法 回顾分析北京协和医院自1988年1月～2000年5月间确诊的70例IE临床特点。结果 (1)8例(11．4％)为人工瓣膜心内膜炎(PVE),62例(88．6％)为自然瓣膜心内膜炎(NVE);57例(91．9％)NVE病人存在各种基础心脏病,其中先天性心血管畸形(22例,38．6％)最常见,其次为特发性二尖瓣脱垂(18例,31．6％)和风湿性心脏病(12例,21．1％)。(2)临床主要表现为发热(100％)、贫血(40例,57．1％)和栓塞(33例,47．1％)。(3)60％(42例)病例细菌培养阳性,23例致病菌为链球菌。(4)39／51例IE经过单纯抗感染治疗痊愈,17／19例经过抗感染治疗联合外科手术治愈。死亡14例,其中包括5例PVE和2例起搏器植入术后IE;顽固性充血性心力衰竭是最常见的死亡原因(9／14)。结论 IE最常见的基础心脏病前3位是先天性心血管畸形、二尖瓣脱垂和风湿性心脏病。不明原因长期发热患者应想到心内膜炎的可能,血培养和超声心动图检查有助于IE的诊断。PVE、起搏器植入术后合并IE以及并发顽固性充血性心力衰竭则预后不良。

A clinical analysis of 70 cases of infective endocarditis

OBJECTIVE: To investigate the clinical characteristics, therapeutical approaches and outcome of infective endocarditis (IE). METHODS: The clinical features, diagnosis, treatment and outcome of 70 IE patients who were treated in Peking Union Medical College Hospital from January 1988 to May 2000 were analyzed. RESULTS: Of the 70 consecutive cases who were diagnosed as IE according to the Duke's new criteria. 38 patients were male and 32 patients female. The average age was (36.1 +/- 16.6) years old. 8 cases were prosthetic valve endocarditis (PVE) and 62 cases native valve endocarditis (NVE). 57 of the 62 (91.9%) NVE patients had pre-existing cardiac abnormalities predisposing to IE, such as congenital cardiovascular disease (22 cases), idiopathic mitral valve prolapse (18 cases), rheumatic heart disease (12 cases), senile degenerative heart disease (3 cases), and permanent pacemaker (PM) implantation 2 cases. Fever (100%), anemia (57.1%) and embolism (47.1%) were the three most common clinical manifestations. Of the 42 cases who had a positive blood culture result, Streptococcus vividans (54.8%) was the most common isolated microorganism. 39 out of the 51 cases receiving antimicrobial therapy and 17 of the 19 cases being treated with combination of antibiotics and surgery were cured. 14 cases including 5 PVE and 2 IE after PM implantation died with a mortality rate of 20%. Intractable congestive heart failure was the leading cause of death. CONCLUSIONS: Congenital cardiovascular diseases and idiopathic mitral valve prolapse were the two most commonly found underlying heart diseases. Blood culture and echocardiogram should always be done to evaluate the possibility of IE while a patient presents with fever of unknown origin, especially when he or she has anemia or embolism. PVE, IE after PM implantation and intractable congestive heart failure were associated with a poor prognosis.