感染性心内膜炎82例临床分析

Clinical Analysis of 82 Cases of Infective Endocarditis

目的分析感染性心内膜炎(IE)患者的临床特征,以提高对其的诊疗水平。方法对1998年11月至2005年3月间在同济医院住院的82例IE患者进行临床资料分析。结果在82例IE患者中有72例进行了血培养,2次或2次以上血培养阳性且为相同病原菌的有35例,阳性率为49%;有81例进行了经胸超声心动图(TTE)检查,发现赘生物65例,阳性率为80%。此外,在37例心脏手术(以瓣膜置换术为主)患者中,术中发现赘生物而术前TTE检查阴性者7例。结论TTE和血培养检查阳性结果是IE的主要诊断依据。但对于临床上怀疑IE,而TTE和血培养检查结果阴性者,不可轻易排除IE,为了防止IE的漏诊,建议行经食管超声心动图(TEE)检查。

Objective To analyze the clinical features of patients with infective endocarditis （IE） for improving its diagnosis and treatment. Methods Clinical data of 82 inpatients with IE between November 1998 and March 2005 in Tongji Hospital were analyzed. Results In 72 cases out of 82 patients having blood culture, 35 were consecutively positive twice or more than twice with the same pathogenic bacteria with the positive rate being 49 %. Among 81 patients who underwent transthoracic echocardiography （TTE）, vegetations were detected in 65 patients with the positive rate being 80%. In addition, in 37 patients subject to cardiac surgery, mostly surgical valve replacement, 7 had negative TTE preoperatively, but vegetations were found during the operation. Conclusion Positive results of TTE and blood culture are the major criteria for the diagnosis of IE. For the patient with clinically suspected IE, while negative TTE and blood culture, the diagnosis of IE should not be easily precluded and TEE is advised to avoid missed diagnosis.