215例感染性心内膜炎临床分析

Clinical Analysis of 215 Cases of Infective Endocarditis

目的：探讨感染性心内膜炎的临床特征，提高感染性心内膜炎的诊治水平。 方法：回顾性分析了２１５例感染性心内膜炎的基础病因、临床表现及并发症等。 结果：感染性心内膜炎基础病因中风湿性心脏病比例（３０．２％）有所下降，而先天性心脏病比例（３４．９％）相对升高，无基础心脏病比例（１６．７％）比以往报道明显增加。发热（占８７．９％）为感染性心内膜炎常见临床表现及首发症状，其次是贫血（６１．９％）及脏器栓塞（２１．９％）。血培养阳性率为５７．７％，其中主要致病菌是草绿色链球菌（３２．４％）和表皮葡萄球菌（１５．５％）。１３４例（６２．３％）超声心动图检查发现赘生物。１７例早期人工瓣膜心内膜炎有８例死亡，占４７．１％。住院期间死亡率为１０．６％，死亡原因主要是心力衰竭和脑血管意外。 结论：感染性心内膜炎基础病因和致病菌发生较明显变化，早期人工瓣膜心内膜炎死亡率高，应尽早手术治疗。

Objective: To improve the diagnosis and treatment of infective endocarditis (IE)by analysing their clinical features. Methods: The underlying disease, clinical features and complication of IE were analyzed retrospectively in 215 patients. Results: The underlying diseases included the rheumatic heart disease (30.2% )and congenital heart diseases (34.9% ). No underlying disease in 36 (16.7%). Fever was the most common and initial symptom (87.9%). Others were anemia (61 .9% )and peripheral vascular embolism (21 .9% ). Positive blood culture was found in 71 patients (57.7% ) of viridans streptococci (32.4% ), staphylococcus epidermidis (15.5% ). Endocardial vegetation was foun in 134 (62.3% ) patients by transthoracic echocardiography. Eight of the 17 patients with early prosthetic valve endocarditis (PVE)died. The major lethal cause was chronic congestive heart failure and cerebrovascular stroke. Conclusion: There are remarkable changes in predisposing diseases and microorganisms. Early PVE has a higher mortality and should be operated for promptly.