亚急性感染性心内膜炎的临床分析

Clinical analysis of subacute infective endocarditis

目的探讨亚急性感染性心内膜炎(SIE)的临床特点和诊断治疗,以期为临床亚急性感染性心内膜炎的治疗提供参考。方法回顾性分析2010年11月-2013年1月医院治疗的35例SIE患者,分析其病因、临床表现、病原菌检测、血培养检查、超声心动图检查以及治疗和转归等,对所有数据采用SPSS13.0软件进行分析,计量资料采用t检验,计数资料采用χ2检验。结果 SIE以风湿性心脏瓣膜病和先天性心脏病为主要病因,以不规则发热为主要临床症状,占97.1%;以心脏杂音为最常见临床体征,占97.1%;主要并发症为充血性心力衰竭,发生率60.0%;SIE的实验室检查中白细胞、中性粒细胞和血沉均有升高,血培养阳性率为82.9%,其中以酿脓链球菌和微需氧链球菌为主;经过>2种抗菌药物及对症支持治疗后,临床效果显著,治愈率为51.4%。结论 SIE的临床诊断应结合临床症状和体征以及辅助检查,特别是血培养和超声心动图的检查;早期使用敏感抗菌药物,可提高治疗效果,而内科治疗无效则最好采用手术治疗。

OBJECTIVE To study the clinical characteristics, diagnosis and treatment of subacute infective endocarditis （SIE） , so as to provide reference for clinical improvement of subacute infective endocarditis. METHODS A retrospective analysis was conducted on 35 patients with SIE treated in our hospital during Nov. 2010 to Jan. 2013. The analysis included pathogenesis, clinical manifestations, pathogen test, blood culture, treatment and outcomes as well as echocardiography. All the data were analyzed using the software SPSSI3. 0, X＇ test was used for enumeration data and t test for measurement data. RESULTS Rheumatic heart valve disease and congenital heart disease were the main cause of SIE. The main clinical manifestation was irregular fever （97. 1 %）, the most common clinical sign was heart murmur （97. 1%）, and the complication of congestive heart failure was the most common （ 60. 0 %）. Laboratory examination for SIE showed elevated white blood cells, neutrophils and blood sedimentation. The positive rate of blood culture was 82. 9 %, mainly due to Streptococcus pyogenes and micro aerobic Streptococcus. Anti-infection treatment with more than 2 kinds of antibiotics and symptomatic treatment achieved significant clinical efficacy, the cure rate was 51. 4 %. CONCLUSION Clinical diagnosis for SIE should be made with combination of observation of clinical symptoms and signs and auxiliary examinations, especially blood culture and echocardiographic examination. Early use of sensitive antibiotics can improve clinical effect, and surgical treatment should be preferably performed if medical therapy fails.