感染性心内膜炎临床诊断与治疗

Clinical diagnosis and treatment of infective endocarditis

目的总结分析感染性心内膜炎患者的临床表现、临床诊断与治疗方法,为疾病的诊断和治疗提供参考依据。方法对2010年3月-2012年12月医院收治的50例感染性心内膜炎患者的临床资料进行回顾性分析。结果 50例患者临床表现以发热、心脏杂音、进行性贫血及肝脾肿大为主,发生率分别为90.0%、82.0%、48.0%、36.0%;对50例感染性心内膜炎患者进行血培养,分离出病原菌39株,排前5位病原菌依次为酿脓链球菌、金黄色葡萄球菌、大肠埃希菌、粪肠球菌、肺炎克雷伯菌,分别占30.77%、17.95%、12.82%、10.26%、10.26%;革兰阳性菌对万古霉素敏感,革兰阴性菌对环丙沙星和头孢噻肟耐药;超声心动图显示原发性心脏疾病24例、心脏瓣膜赘生物患者46例;经抗菌药物治疗结合相应的外科手术治疗后,痊愈32例、显效11例、有效6例、死亡1例,总有效率为76.0%。结论根据感染性心内膜炎的临床特征,作出早期诊断及抗菌药物治疗结合相应的外科手术治疗可有效提高患者的治疗效果。

OBJECTIVE To summarize and analyze the clinical manifestations, diagnosis and treatment of infective endocarditis in patients, so as to provide reference to clinical diagnosis and treatment. METHODS The clinical data from 50 cases of infective endocarditis patients admitted in our hospital from Mar. 2010 to Dec. 2012 were retro- spectively analyzed. RESULTS The main clinical manifestations in 50 patients were fever, heart murmur, progres- sive anemia, hepatosplenomegaly, and the occurrence rates of them were 90.0%/00, 82.0%, 48.0%, and 36.0%, respectively; a total of 39 strains of pathogenic bacteria were isolated after blood culture from the 50 patients with infective endocarditis, of which the top 5 pathogens were Streptococcus pyogenes, Staphylococcus aureus, Esche- richia coli , Enterococcus f aecalis and K lebsiella pneumonia e , accounting for 30. 77%, 17. 95% 12.82%, 10.26% and 10.26%, respectively; gram-positive bacteria were sensitive to vancomycin, and gram-negative bac- teria had drug resistance to ciprofloxacin and cefotaxime; echocardiography showed that there were 24 cases of pri- mary cardiac disease and 46 patients with cardiac valvular vegetations; after the antibiotics treatment combined with surgical treatment, 32 patients were cured, 11 cases markedly effective, 6 cases effective, and 1 case died, and the total effective rate was 76.0%. CONCLUSION Based on the clinical characteristics of infective endocardi- tis, making an early diagnosis and using the antibiotics treatment combined with surgical therapy can effectively improve the therapeutic effect.