感染性心内膜炎161例手术治疗及诊断依据探讨

Diagnostic evidence of surgical treatment of infective endocarditis in 161 cases

目的:探讨感染性心内膜炎的临床诊断依据,为感染性心内膜炎手术治疗提供临床参考。方法:回顾分析北京安贞医院心外九病区近10年来(2007年1月至2016年12月)手术治疗感染性心内膜炎患者临床资料(基本情况、血常规、肝肾功能、血培养、心电图、超声心动图、手术情况),以改良Duke标准为诊断依据。结果:161例患者中,术前有反复发热病史126例,占78.3%;术前行血培养149例,阳性率20.1%;术前超声发现瓣膜赘生物130例,阳性率80.7%。依照改良Duke标准,术前确诊8例,疑似诊断106例,另有47例患者为手术中证实。结论:超声心动图是感染性心内膜炎的重要诊断手段,重复多次检查有助于提高诊断阳性率;加强对感染性心内膜炎的认识、充分详实的病史采集、体格检查、以及实验室数据将有助于临床诊断率的提高。

Objective： To explore the clinical diagnostic criteria of infective endocarditis in order to provide clinical reference for treatment of IE. Method： Collecting the clinical data（ General condition, blood routine test, liver and kidney function, blood culture, electrocardiogram, eehocardiography, operation） of patients with infective endoearditis who were admitted to ward 9 in Beijing Anzhen Hospital during 10 years （January 2007 to December 2016 ）. The modified Duke criteria were used as diagnostic criteria. Results： According to the modified Duke criteria, 126 /161 cases have history of repeated fever, accounting 78.3 %. Preoperative blood cuhure 149 cases, the positive rate was 20. 1%; preoperative ultrasound found valve vegetation in 130 cases, the positive rate was 80.7%. In the total of 114 eases,8 cases can be confirmed preoperatively and 106 cases can be suspected to IE. Conclusion： Echocardiography is an important diagnostic method of infective endoearditis, repeated several tests will help to improve the sensitivity of diagnosis. To enhance the understanding of infective endocarditis, full and detailed medical history collection, physical examination, and laboratory data will help improve the clinical diagnosis.