感染性心内膜炎的临床分析(附69例病例报告)

Analysis of characteristics in infective endocarditis (with report of 69 cases)

目的 总结感染性心内膜炎(IE)的临床资料,分析其临床特征和治疗情况,提高对此病的认识。方法 回顾性分析北京协和医院近10年收治的IE 69例。结果 临床表现前三位分别为:发热(97.1%),肝大(43.5%)及脾大(27.5%)。血培养阳性率为65.2%,致病菌以草绿色链球菌(35.3%)为主。经食管超声心动图(TEE)赘生物的检出率明显高于经胸壁超声心动图(TTE),两者分别为100%及82.4%。治愈38例(55.1%),需手术21例(30.4%),死亡10例,病死率为14.5%。结论 IE目前仍是一种死亡率较高、危害性较大,不易确诊的疾病,超声心动图可作为IE的诊断标准之一,对可疑患者及有条件的医疗单位应行TEE检查。

Objective To make a retrospective study of infective endocarditis (IE) and analyse the clinical characteristics and the treatment of this disease, in order to improve the diagnosis and treatment of IE. Methods 69 cases of IE admitted to PUMC hospital from 1990 to May 2000 were analysed. Results The commonest clinical characteristic was fever(97.1%), the following were hepatomegaly(43. 5%) and splenomegaly(27. 5%). The positive rate of blood culture was 65. 2%, the commonest nosogenic bacteria was grass green streptococcus (35. 3%). Trans-esophageal echocardiography(TEE) has more sensitive than transthoracic echocardiography(TTE)in checking neoplasm. After treatment in hospital 38 cases(55. 1%) were completely recover, 21 cases(30. 4%) needed operation, 10 cases were dead, the mortality is 14. 5%. Conclusions IE is a disease which has high mortality and high hazard. As it is hard to diagnose, UCG can be regarded as one of criterion in diagnosis of IE. In order to improve the diagnosis and treatment of IE, we need to take the TEE check as early as possible, and treat this disease early and properly, reduce the mortality at last.