77例感染性心内膜炎临床诊断及治疗

Clinical Diagnosis and Treatment of Infective Endocarditis:An Analysis of 77 Cases

目的总结感染性心内膜炎(IE)的临床诊断及治疗体会。方法对77例诊断为IE患者的病历档案[一般资料、基础心脏病、临床表现、辅助检查(超声心动图)及实验室检查(常规检查及血培养)、治疗及转归等]进行回顾性分析。结果 77例患者中白细胞计数升高30例(38.9%)、红细胞沉降率升高47例(61.0%),C反应蛋白升高55例(71.4%)。血培养阳性46例,阳性率为59.7%,其中最常见的致病菌为链球菌(63.0%);基础心脏病以先天性心脏病(53.2%)和风湿性心瓣膜病(31.2%)多见;超声心动图提示有心内膜赘生物者61例(79.2%)。77例患者均进行抗感染(29±6)d治疗,其中84.4%的患者抗感染疗程达4周以上。治疗好转者65例(84.4%),死亡5例(6.5%),因经济或其他原因自动出院者7例(9.1%)。抗感染治疗后接受外科手术者24例(31.2%),均平稳度过手术期,病情稳定出院。结论对感染性心内膜炎患者进行早期诊断,选用敏感杀菌抗生素正规治疗,掌握适当的手术时机,联合内科治疗和外科手术,可取得良好的治疗效果,降低病死率。

Objective To summarize the clinical experience with diagnosis and treatment of in-fective endocarditis(IE).Methods Clinical data of 77 IE patients(general information,basic heart disease,clinical manifestation,ultrasonic cardiogram,routine examination,blood culture,treatment and outcome)were analyzed retrospectively.Results Among the 77 patients,30(38.9%)had ele-vated white blood cell count,47(61.0%)had elevated erythrocyte sedimentation rate,55(71.4%) had elevated C-reactive protein,and 46(59.7%)had positive blood culture results.The most com-mon pathogenic bacteria were Streptococcus(63.0%).The common basic heart diseases included congenital heart disease(53.2%)and rheumatic valvular heart disease(31.2%).Echocardiography showed endocardial vegetations in 61 patients(79.2%).All the 77 patients were given anti-infec-tion treatment for(29±6)days,and 84.4% of them were treated for longer than 4 weeks.Among the 77 patients,65(84.4%)achieved improvement,5(6.5%)died,7(9.1%)were discharged a-gainst medical advice because of economic or other reasons,and 24(31.2%)successfully under-went surgery and were discharged with stable disease.Conclusion Early diagnosis,standard treatment with bactericidal antibiotics,appropriate surgical timing,and combined internal medi-cine and surgical procedure provide effective treatment and reduce mortality in patients with IE.