39例感染性心内膜炎的回顾性分析

Retrospective analysis of 39 cases with infective endocarditis

目的通过回顾性研究,探讨感染性心内膜炎患者的临床表现特点、细菌学变化、辅助检查的特点及治疗时机的把握,总结近8年本院确诊为感染性心内膜炎(IE)患者的特征,以提高诊治水平。方法统计自2010年1月至2017年12月本院感染内科、心内科、心外科共收治确诊IE患者39例,通过回顾性病例分析,总结39例IE患者基本病因、临床症状、体征、辅助检查、治疗转归的特点。结果应用Excel 2010统计记录及SPSS 20.0软件进行进一步统计学分析。结果全组死亡率7.69%(3/39),均为内科治疗不佳死亡,通过外科手术后,无病死患者,血培养阳性率41.03%(16/39),超声心动图探及瓣膜赘生物率82.05%(32/39)。结论目前感染性心内膜炎病因主要是先天性心脏疾患,风湿性心脏病所致的心内膜炎已经越来越少,早期诊断及合理选择抗生素与手术时机是十分关键的,临床上超声心动图的意义大于血培养,血培养阳性率欠满意,同时菌种较既往略有变化,与国外大部分报道不尽相同;原发病与肾功能之间存在相互影响的作用,监测肾功能是必须的。

Objective The clinical features, bacteriological changes, the characteristics of auxilia- ry examination and the timing of treatment in patients with infective endocarditis （IE） were discussed in the study retrospectively. The characteristics of the patients with infective endocarditis in our hospital in the last 8 years were summarized in order to improve the level of diagnosis and treatment. Methods From Jan. 2010 to Dec. 2017, 39 cases of IE were admitted from the department of infectious medicine, cardiology and heart surgery in our hospital. The basic causes, clinical symptoms, signs, auxiliary examination and treatment outcome were summarized through retrospective case analysis. The results were recorded by Excel 2010 and analysed by SPSS 20. 0 software. Results The total mortality rate was 7.69% （3/39）, all of which were ill treated in internal medicine. After surgery, there was no death in patients, the positive rate of blood culture was 41.03% （ 16/39）, and the rate of valvular neoplasm was 82. 05% （32/39） by echocardiography. Conclusions At present, the main cause of infective endocarditis is congenital heart disease, and the endocarditis caused by rheumatic heart disease is becoming less. Early diagnosis and rational selection of antibiotics and the time of operation are very critical. The significance of clinical echocardiography is greater than that of blood culture. Since the positive rate of blood culture is not satisfactory, and the strain of the bacteria has changed slightly compared with the previous reports in most foreign countries. And there is a mutual influence between the primary disease and the renal function, so it is necessary to monitor the renal function.