细菌性心内膜炎的临床分析

Clinical Analysis of Bacterial Endocarditis

目的：为提高对细菌性心内膜炎的诊治水平。方法：回顾性分析４４例细菌性心内膜炎的临床表现形式与治疗的关系。结果：发热为常见及起始症状（９７．７％）；贫血（８６．４％）、脾大（４３．２％）、肝大（３８．６％）、心脏杂音改变（３４．１％）、周围动脉栓塞（２０．５％）、脑血管意外（１１．９％）、血培养阳性（５６．８％），其中葡萄球菌及链球菌分别为４６．２％及３５．７％，经胸超声心动图发现赘生物７２．７％，瓣周漏４．５％，主动脉根部脓肿２．３％。内科治疗３２例，死亡率３４．４％，外科治疗１２例，死亡率８．３％，６例早发性人工瓣膜心内膜炎中５例在发病后１个月内死亡。多种细菌感染、心功能、周围动脉栓塞、早发性人工瓣膜心内膜炎、主动脉瓣病变为危险因素。结论：应根据心功能、致病菌种、受累部位以及临床症状决定治疗方案，对于人工瓣膜心内膜炎应首先考虑手术治疗。

? Objective:To improve the diagnosis and treatment for bacterial endocarditis. Methods:Forty four cases of bacterial endocarditis were retrospectively analyzed to outline the clinical characteristics and the treatment strategy. Results:Fever was the most common and initial symptom(977%),then anemia(864%),splenomegaly(432%),hepatomegaly(386%),changing of heart murmur(341%),peripheral vascular embolism(205%) and cerebrovascualr accident(119%).Positive blood culture was found in 25 cases(568%):Staphylococcus(462%),streptococcus(357%).Transthoracic echocardiography findings:Vegetation were found in 727%,paravalvular leak in 45% and aortic root abscess in 23%.Five of the 6 cases of early prosthetic valve endocarditis(PVE)died within one month.Thirtytwo patients were treated medically and the mortality was 344%,12 patients were treated surgically and the mortality was 83%.The risk factors were polymicrobial infection,poor heart function,peripheral arterial embolism,early PVE and aortic valve lesion. Conclusion:Therapeutic must be based on the clinical status,heart function,infective microorganism and involved valve.Early PVE operation should be performed promptly.