感染性心内膜炎患者血培养阴性临床分析

Clinical analysis of negative blood culture in patients with infective endocarditis

目的探讨感染性心内膜炎患者血培养阴性临床表现和外科手术治疗的效果,以寻找最佳的治疗方法,提高临床治疗水平。方法选取2010年5月-2013年5月37例血培养阴性感染性心内膜炎患者为研究对象,对其临床表现、实验室检查结果进行总结,并对其中的31例患者进行手术治疗,观察治疗后临床效果。结果临床表现中发热占83.78%、心功能不全占78.38%、心脏杂音占81.08%、皮肤黏膜出血占40.54%;实验室检查中抗核抗体阳性率为35.13%,心电图主要表现为心室肥大占75.68%,而超声心动图表现为瓣膜赘生物占97.30%,瓣膜穿孔占56.76%;治疗后无死亡病例,赘生物病理证实为炎性细胞聚集,血栓形成,治疗前心功能Ⅰ级占13.51%、Ⅳ级占24.32%,治疗后Ⅰ级占75.68%、Ⅳ级为0,治疗前后比较差异有统计学意义(P<0.05)。结论血培养阴性感染性心内膜炎临床症状不明显,外科手术治疗后临床效果尚可。

OBJECTIVE To investigate the clinical manifestations of patients with infective endocarditis whose blood culture were negative and the surgical treatment results in order to find the best treatment methods to improve the level of clinical treatment. METHODS Totally 37 patients with infective endocarditis whose blood culture were negative during May 2010 to May 2013 were selected as the research subjects. The clinical manifestations and laboratory test results were summarized, and 31 out of the 37 patients received surgical treatment, and the clinical effects of treatment were observed. RESULTS The clinical manifestations of fever accounted for 83.78%, heart failure accounted for 78.38%, heart murmur accounted for 81.08%, and mucocutaneous bleeding accounted for 40.54%. The laboratory positive rate for antinuclear antibody was 35.13%. The main ECG manifestation was ventricular hypertrophy, accounting for 75.68%. , while echocardiography showed valvular vegetations accounting for 97.3% and valvular perforation accounting for 56.76 %. After treatment, no deaths occurred. Vegetation was pathologically confirmed to be inflammatory cell aggregation and thrombosis. Cardiac function of grade I accounted for 13.51%, and grade 1V accounted for 24.32% before treatment, which accounted for 75.68% and 0% after treatment, with statistical significance （P〈0.05）. CONCLUSIONS The clinical symptoms of patients with infective endocarditis who had negative blood culture were not obvious, the effect of surgical treatment was acceptable.