感染性心内膜炎68例临床特点及治疗演变分析

Analyzing of the evolutionary trend of clinical features and therapy in 68 cases of infective endocarditis

目的分析感染性心内膜炎(IE)临床特点的演变趋势。方法回顾性分析1987年7月至2007年7月北京大学第三医院确诊的68例IE患者病例资料,比较前后10年的临床表现。结果68例患者中有基础心脏病者61例(89.7%),发热67例(98.5%),心脏杂音62例(91.2%);经胸超声心动图赘生物检出率为83.8%(57/68),血培养阳性率60.3%(41/68);外科手术治愈率19.1%;总体治愈率66.7%(52/68)。前后10年比较:近10年发病年龄推后[(36.7±12.7)岁对(44.4±18.6)岁,P<0.05];基础心脏病中先天性心脏病和风湿性心脏病比例减少(分别44.4%对24.4%和33.3%对17.1%,P<0.05),而瓣膜松弛症的比例增加(0对29.3%);心力衰竭、器官或血管栓塞发生率在近10年显著下降(77.8%对46.3%和44.4%对17.1%,P<0.05)。结论IE临床表现复杂,发热、心脏杂音仍为主要症状;近10年发病年龄推后;及时、反复血培养和超声心动图检查可提高确诊率,规范、充分的抗生素治疗和及时、合理的手术治疗可降低病死率。

Objective To analyze the evolutionary trend of clinical features in infective endocarditis. Methods The study enrolled 68 patients who were diagnosed as having infective endocarditis from July 1987 to July 2007. The patients were divided into two groups：group Ⅰ included patients from 1987 to 1997 ,group Ⅱ included patients from 1997 to 2007. All clinic data were compared. Results In both groups,61 patients（89. 7% ） had basic heart diseases,67 patients（98.5% ） had fever and 62 patients（ 91.2% ）had cardiac murmur;41 patients （60. 3% ） had positive results in the blood culture. Vegetations were found in 57 cases（83. 8% ） by eehocardiography. The rate of surgical treatment was 19. 1% ,the total cure rate was 66. 7%. Comparing the data between the two groups,age of onset changed from （36. 7 ± 12. 7） years to （ 44. 4 ± 18.6 ） years （ P 〈 0. 05 ）, the proportion of congenital heart disease and rheumatic heart disease as the basic heart diseases decreased（respectively,44. 4% vs 24. 4% ＆ 33. 3% vs 17.1% ,P 〈0.05） ,the proportion of floopy valve increased（0 vs 29. 3% ） ,heart failure and organic or artery embolism incidence decreased（ respectively ,77.8% vs 46. 3% ＆ 44. 4% vs 17.1% ,P 〈 0.05 ） over time. Conclusion Our study showed that IE was complex and subtle. Fever,cardiac murmur and history of heart disease were the main diagnostic clues. In the past 2 decades, the age of onset of IE was delayed. Blood cultures and echoeardiography can confirm the diagnosis and lead to early treatment with bactericidal antibiotics. In some cases surgery could be a reasonable choice.