老年患者感染性心内膜炎的临床病原学特征研究

Study on clinical pathogenic characteristics of elderly patients with infective endocarditis

目的探讨老年患者感染性心内膜炎的临床病原学特征与生存状况,为感染性心内膜炎的诊治提供临床资料。方法回顾性分析2011年1月-2014年1月100例感染性心内膜炎年龄>60岁患者的临床资料,统计其临床和病原学特征,并采用单因素方差分析和多因素logistic回归分析,分析影响感染性内膜炎老年患者生存的危险因素。结果 100例患者的病变位置左心82例占82.0%、右心5例占5.0%、左右心均出现病变的患者7例占7.0%,不明确病变位置的6例占6.0%;100例患者中伴有心脏基础疾病41例占41.0%;动脉血培养呈阳性47例占47.0%,检出病原菌47株,以酿脓链球菌为主24株占51.0%;医院感染、血红蛋白<90g/L是影响老年患者感染性心内膜炎生存的危险因素,手术治疗是保护性因素。结论感染性心内膜炎老年患者的主要病原菌为酿脓链球菌,应预防控制其危险因素,手术治疗是保护性因素。

OBJECTIVE To explore the clinical pathogenic characteristics and survival status in elderly patients with infective endocarditis so as to provide clinical data for the diagnosis and treatment of infective endocarditis.METHODS A retrospective analysis of the clinical data of 100 cases of patients older than 60 years old with infective endocarditis from Jan.2011 to Jan.2014 was conducted.The clinical features and pathogenic characteristics were analyzed by one-way analysis of variance and logistic multiple regression analysis.The risk factors of endometrial inflammation in elderly patients were summarized.RESULTS Totally 82 cases in the 100 cases of patients had left heart lesion,accounting for 82%,and 5cases got right heart lesion,accounting for 5%.A total of 7cases appeared both left and right heart lesion,accounting for 7%.Another 6cases had unclear heart lesion,accounting for 6%.In 100 patients,41cases（41%）with cardiac basic diseases,47cases（47%）were positive in arterial blood culture.Totally 47 strains of pathogens were detected and they were mainly Streptococcus viridans with 24strains（51.1 %）.The results showed that nosocomial infections,hemoglobin 90g/L were risk factors for the survival of patients with senile infective endocarditis and surgery treatment was a protective factor.CONCLUSION The main infectious pathogen causing endocarditis in elderly patients was S.viridans,and the risk factors should be prevented and controlled.Operational treatments as a protective factor can be applied.