肝硬化患者合并感染性心内膜炎8例临床分析并文献复习

Clinical analysis of 8 cases of infectious endocarditis in patients with cirrhosis of the liver

目的探讨肝硬化患者并发感染性心内膜炎的临床特点,以提高临床医生对其的认识。方法回顾性分析本院确诊的8例肝硬化患者并发感染性心内膜炎的临床资料。结果 8例患者中,男4例,病程为1周至24个月。主要临床表现为发热(8/8)、栓塞(4/8)。随访的5例患者1年内病死率为80%(4/5),死亡的原因是急性心功能衰竭、肺栓塞、肝功能衰竭、呼吸衰竭。1例患者接受了手术治疗,术后感染性心内膜炎复发后死亡。结论肝硬化患者并发感染性心内膜炎临床表现具有起病隐匿、病程长等特点,早期诊断及内外科联合治疗有利于改善预后。

Objective To investigate the clinical characteristics,therapeutic approaches and outcomes of infectious endocarditis in patients with cirrhosis of the liver. Method The clinical profiles of 8 patients with cirrhosis of the liver,who were treated in Fuwai Cardiovascular Hospital from 2003 to 2013,were analyzed. Result Of the 8 patients,4 patients were male. The duration before diagnosis was from 1 week to 24 months. Fever（8 /8） and embolism（4/8） were the most common clinical manifestations. The mortality at one year in5 patients on follow-up were80%（4/5）. Cardiac failure,acute liver failure,acute respiratory failure and pulmonary embolism were the most common causes of death. One patient received the cardiac surgery successfully,and died after 3 months due to relapse of infectious endocardititis. Conclusion Clinical features of infectious endocarditis in patients with cirrhosis of the liver are insidious onset and longer course. Early diagnosis and medical therapy combined with surgical management are helpful for improving the outcomes.