感染性心内膜炎的临床变迁──38年间153例临床对比分析

CHANGES IN CLINICAL FEATURES OF INFECTIOUS ENDOCARDITIS──CLINICAL ANALYSIS OF 153 CASES DURING 38 YEARS

本文回顾性地探讨了我院３８年来住院感染性心内膜炎１５３例，对比观察了１９７９年以前及以后的有关临床表现及特点，结果显示：风湿性心脏瓣膜病作为基础心脏病因大幅度下降，而先天性心脏病和缺乏基础心脏病因者明显上升。致病菌方面草绿色链球菌明显减少，金黄色葡萄球菌、致病性大肠杆菌明显上升。培养阳性率低，Ⅰ、Ⅱ组分别为３０．７％和２３．７％。发热、贫血、白细胞增加、肝脾大、杵状指、心脏杂音等仍是其主要临床表现，而皮肤损害、杂音变化则明显减少。超声心动图对感染性心内膜炎的诊断具有重要价值。心力衰竭、肾功能衰竭及栓塞是感染性心内膜炎的主要死因。

One hundred and fifty three in-patients with infectious endocarditis were studied retrospectively. The clinical manifestations and clinical features before 1979(1957-1979,group Ⅰ)and after 1979(1980-1994 group Ⅱ)were analyzed.By comparing group Ⅱ with group I,cases with rheumatic heart disease as the basic heart disease decreased significantly,while those with congenital heart diseases or without basic heart disease increased significantly;as for the pathogenic bacteria,endocarditis due to streptococcus viridans decreased significantly and that due to staphylococcus aureus and pathogenic bacillus coli increased significantly;positive culture rate decreased(30.7% vs.23.7%);fever,anemia,increase of WBC number,hepatomegaly,splenomegaly,clubbed finger,and heart murmur were still the main clinical manifestations;skin lesions and changes in heart murmur decreasd significantly.Echocardiography is very valuable for the diagnosis of infectious endocarditis.Heart failure,renal failure and embolism were the main causes of death.