感染性心内膜炎合并脑血管病临床及影像学特点

Clinical and image characteristics of cerebrovascular complications of infective endocarditis

目的探讨感染性心内膜炎(IE)合并脑血管病的临床和影像学特点,提高IE的诊治水平。方法对32例IE患者及36次IE发作的血培养和经胸超声心动图检查及合并脑血管病时的头部影像学检查进行回顾性分析。结果对入选的IE患者血培养结果进行分析,排在首位的致病菌为金黄色葡萄球菌(12.5%),其次是草绿色链球菌(6.3%)。对经胸超声心动图检查进行分析,先天性心脏病(34.4%)和心脏瓣膜病(31.3%)为主要心脏病因,风湿性心脏病(12.5%)所占的比率越来越小。合并脑血管病9例,发病率为28.1%,其中脑栓塞6例,脑出血3例。对合并脑血管病的IE患者血培养结果及经胸超声心动图检查进行分析,致病菌无特殊性,血培养阳性是IE患者易合并脑血管病的危险因素,心脏病因以心脏瓣膜病(44.4%)为主,其次为先天性心脏病(22.2%)。头部影像学检查提示脑出血部位多位于脑叶,并且靠近大脑皮层;脑栓塞部位无特殊性。结论IE的致病菌和心脏病病因及临床表现均发生了许多变化,对合并脑血管病的IE患者早确诊及完善影像学检查非常重要,治疗仍以抗菌治疗为主,必要时可行颅骨钻孔血肿引流术。

[Objective] To improve the diagnostic and treatment level of infective endoearditis （IE） through investigating clinical characteristics of IE and clinical and image features of eerebrovaseular complications of IE. [Methods] Thirty-two patients with IE and thirty-six arises were studied, the result of blood culture, the inspection of transthoraeie eehoeardiography and image characteristics of eerebrovaseular complications were retrospectively analyzed. [Results] Through analysis of the result of blood culture, staphylococcus（12.5%） was the first of pathogenic germs, streptococcus （6.3%） was the second. Through analysis of the inspection of transthoraeie eehoeardiography, congenital heart disease （34.4%） and the valvular heart diseases （31.3%） were the main heart disease, but the proportion of the rheumatic heart disease （12.5%） was decreasing. There were nine patients with eerebrovaseular complications of IE, the eomorbidity rate was 28.1%,in which there were six cerebral embolisms and three cerebral hemorrhages. Analyzing the result of blood culture and the inspection of transthoraeie eehoeardiography of patients with eerebrovaseular complications, there was not particular in pathogenic germs, the positive result of blood culture was the dangerous factor of IE patient merged eerebrovaseular complications, and the main heart disease was the valvular heart diseases（44.4%）, the next was congenital heart diseases （22.2%）. Through the inspection of coronal image, the spots of cerebral hemorrhage located in the brain leaf approaching the cerebral cortex mostly, and the spots of cerebral embolism did not have particularity. [Conclusion] The pathogenic germs and the causes of heart disease and the clinical manifestations of IE have many changed greatly. It is very important to recognize the disease and have perfect image inspection to the patients with cerebrovascular complication. The main treatment is still antibacterial treatment. Drilling hole of skull will be used necessarily.