44例感染性心内膜炎回顾性分析

Retrospective analysis of 44 patients with infective endocarditis

目的 探讨感染性心内膜炎 (IE)的病因、致病微生物的变迁、手术时机的选择等因素。方法 对 1994年 9月至 2 0 0 1年 9月间住院的 4 4例IE患者进行分析。男 2 9例 ,女 12例 ,平均年龄 31岁 ,病因包括先天性心脏病、风湿性心脏瓣膜病、心脏病术后、瓣膜脱垂等。手术治疗 30例 ,手术指征主要为进行性慢性心力衰竭和超声心动图发现赘生物 ,绝大多数患者进行了瓣膜置换术。结果 分析显示 ,IE有逐年增加的趋势 ,呼吸道感染为主要的诱因 ,IE最常见的并发症是心力衰竭和脑血管意外。 77%患者分离出病原菌 ,其中组织培养阳性率明显高于血培养 (89%和 4 4 % ,P <0 0 5 )。最常见的致病菌为葡萄球菌 ,其次为草绿色链球菌和嗜麦芽假单胞菌。结论 对进行性心力衰竭 ,超声心动图发现赘生物 ,耐抗生素及持续性脓毒血症和非致命性栓塞的IE患者应尽早手术治疗 。

Objective To investigate causes, vicissitudes of pathogenic microorganism, timing of surgical procedure and risk factors in infective endocarditis (IE) Methods Fourty four inpatients with IE during September of 1994 to September of 2001 were studied There were 32 male and 12 female (mean age 31 years) Besides rheumatic valve disease, congenital heart disease and post cardiac surgery, the etiology included valve prolapse and no history of cardiac diseases and so on Thirty patients underwent cardiac surgery because of progressive heart failure and echocardiographic finding of vegetation Most of the patients underwent valve replacement Results The incidence of IE increased yearly The common inducing factor was respiratory infection The most common complication of IE was congestive heart failure and cerebrovascular diseases Organisms were isolated from 77% patients, for which the positive rate from tissue culture was significantly higher than that from blood culture (89% vs 44%, P <0 05) Staphylococcus was the most common organism, and then followed by streptococcus viridans and stenotrophomonas maltophilia Conclusion In IE, early surgical intervention is recommended in patients with progressive cardiac failure, vegetation on echocardiography, resistance to antibiotics, persistting pyemia or no fatal emboli However, attention should be paid to tissue culture for microorganism in patients with cardiac surgery and intensive therapy to respiratory tract infection in patients with heart disease