61例感染性心内膜炎的临床分析

Clinical analysis of 61 patients with infectious endocarditis

目的探讨近年来感染性心内膜炎临床特点的变化.方法回顾性分析我院1992年1月～2004年11月间61例感染性心内膜炎患者的临床资料,根据受累瓣膜种类(人工瓣或自然瓣)、血培养结果(阳性或阴性)、是否检出瓣膜赘生物将患者分为不同亚组,分析其对预后的影响.结果风湿性心脏病(27.9%)、先天性心脏病(21.3%)、特发性二尖瓣脱垂及关闭不全(19.6%)分别居基础疾病的前3位.临床表现的发生率由高到低依次为贫血34例(55.7%)、肝脾肿大29例(47.5%)、不规则发热22例(36.1%)、血尿12例(19.7%)、脑血管意外10例 (16.4%) .经超声心动图检查42例(68.9%)发现赘生物,细菌培养结果31例为阳性.致病菌主要为链球菌(10株)、葡萄球菌(10株)、假单胞菌(3株).常用的有效抗生素组合为去甲万古霉素+磷霉素+奈替米星 (34.4%) 、青霉素+氨基糖苷类(27.9%).手术治疗22例(36.1%),住院期间死亡11例(18.0%),主要死因为心力衰竭,其次为脑血管意外.不同亚组间住院病死率的差异无显著性(P>0.05).结论瓣膜种类、血培养结果及是否检出瓣膜赘生物对预后无明显影响,早期诊断、适时手术及内、外科联合治疗是治疗成功的关键.

Objective To appraise the changes of clinical characteristics in patients with infectious endocarditis (IE) and to analyze the effects of kinds concerning the heart valve, positive blood culture and presence of valvular vegetations together with the prognosis. Methods The clinical data of 61 patients with IE treated in Huashan hospital from January 1992 to November 2004 were retrospectively analyzed. The patients were divided into three subgroups according to the prosthetic or nature valve, positive or negative blood culture and presence or absence of vegetations. Results There were marked changes with predisposing diseases and microorganisms. Rheumatic heart disease(27.9%), congenital cardiovascular diseases(21.3%) and idiopathic mitral valve prolapse and imcompetence(19.6%)were the most common seen among them. Clinical manitafestations were: irregular fever(22 cases,36.1%), anemia(34 cases,55.7%), hepatosplenomegaly(29 cases,47.5%),hematuria(12 cases,19.7%) and stroke(10 cases,16.4%).The valvular vegetations were found in 42 patients(68.9%)by echocardiogram. There were 31 patients with positive blood culture, including the most commonly occurances of Streptococci (10 cases), Staphylococci (10 cases) and pseudomonas (3 cases). The most effective antibiotics combinations were Norvancomycin + Fosfomycin + Netilmycin(34.4%)and penicillin + Aminoglycosides (27.9%). Heart valve replacement surgery was performed in 22 patients(36.1%). 11 patients(18.0%)died during hospitalization. There was no definite relationship between the kinds of heart valve used , blood culture, presence of vegetations and the prognosis. Conclusions Kind of heart valves, blood culture and detection of vegetations are not relevant to the prognosis. Early diagnosis, aggressive medical treatment combined with appropriate surgical therapy are keys to successful management of IE.