| 摘要: |
| ［摘要］ 目的 分析感染性心内膜炎(IE)的临床表现、基础心脏病因、致病微生物、受累瓣膜等临床特点以及治疗效果，提高IE的诊治水平。方法 回顾性分析1999-01～2008-12共104例经外科手术治疗的IE患者的临床资料。结果 >60岁者有13例(12.5%)；发热89例(85.58%)，贫血75例(72.12%)，消瘦、乏力61例(58.63%)，心脏杂音101例(97.12%)；先天性心脏病45例(43.7%)、风湿性心脏病33例(31.73%)，静脉药瘾者7例(6.73%)；87例患者进行了血培养，阳性52例(59.77%)，其中链球菌25例(48.08%)，葡萄球菌17例(32.69%)，真菌2例(3.85%)；83例(79.81%)经胸超声心动图(TTE)检查发现赘生物，主动脉瓣36例(34.62%)，二尖瓣17例(16.35%)，三尖瓣11例(10.58%)，联合瓣膜9例(8.65%)。术后早期死亡4例(3.85%)。随访89例(85.6%)，随访时间1～112 个月，无心内膜炎复发，心功能恢复至Ⅰ级66例(74.16%)，Ⅱ级23例(25.84%)。结论 IE的平均发病年龄有增大趋势；发热和心脏杂音是最常见的临床表现；风湿性心脏病和先天性心脏病是IE常见的基础心脏疾病，且先天性心脏病比例已超过风湿性心脏病；草绿色链球菌仍是IE最常见的致病菌；IE常累及主动脉瓣；IE的确诊主要依靠血培养和TTE检查；及时外科手术治疗，疗效确切。 |
| 关键词: 感染性心内膜炎 临床特点 血培养 超声心动图 |
| DOI：10.3969/j.issn.1674-3806.2009.04.027 |
| 分类号:R 542.5 |
| 基金项目: |
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| Clinical characteristic analysis of infective endocarditis(report of 104 cases) |
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GAN Chong-zhi, LIU Sheng-zhong, CONG Wei
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Cardiothoracic Surgical Department of Sichuan Academy of Medical Sciences & Sichuan People′s Hospital, Chengdu 610072, China
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| Abstract: |
| ［Abstract］ Objective To improve the diagnosis and treatment of infective endocardits(IE) by analyzing its clinical characteristics such as clinical manifestations, basic heart disease, pathogenic micro-organisms and involved valve.Methods The clinical data of 104 cases of IE underwent cardiac surgery from January 1999 to December 2008 were retrospectively analyzed.Results The whole group included 13 cases over 60 years old(12.5%), 89 cases with fever(85.58%), 75 cases with anemia(72.12%), 61 cases with weight loss and weak(58.65%), 101 cases with heart murmur(97.12%), 45 cases with congenital heart disease, 33 cases with rheumatic heart disease and 7 cases with intravenous drug use. Blood culture were positive in 52 cases of 87 cases(52/87,59.77%). Streptococcus were found in 25 cases(48.08%), Staphylococcus aureus in 17 cases (32.69%) and fungal in 2 cases. Vegetations were revealed by transthoracic echocardiography(TTE) in 83 cases. Aortic valve in 36 cases(34.62%), mitral valve in 17 cases(16.35%), tricuspid in 11cases(10.58%) and joint valve in 9 cases(8.65%) were involved. There were 4 cases of early-death. 89 cases were followed-up for 1～112 months without recurrence. Postoperative cardiac function (NYHA) of 66 cases recovered to grade Ⅰand 23 cases to grade Ⅱ.Conclusion The average age of onset of IE is increasing. Fever and heart murmur are the most common clinical manifestations. Rheumatic heart disease and congenital heart disease are the common basic heart disease, and the ratio of congenital heart disease is more than that of rheumatic heart disease. Streptococcus viridans is still the predominant organism.The aortic valve is often involved. The diagnosis mainly depends on blood culture and TTE examination. A good therapeutic effect of IE could be provided through timely surgical treatment. |
| Key words: Infective endocarditis Clinical characteristic Blood culture Echocardiogram |
