感染性心内膜炎89例临床分析

Analysis of clinical characteristics of 89 patients with infective endocarditis

目的探讨感染性心内膜炎（IE）的基础病因、致病微生物、临床特征及诊断及治疗转归等，提高IE的诊治水平。方法分析2006年1月至2016年1月赣州市人民医院和赣州市立医院收治的89例感染性心内膜炎患者的临床资料，对其临床特点进行回顾性分析。结果在基础病因中，先天性心脏病占首位40．5％，风湿性心脏病占33．7％，心脏手术后组占18．0％，无基础心脏病的患者占7．9％。临床表现常见有发热（86．5％），其次为贫血（85．4％）。血培养阳性率为63．4％，其中草绿色链球菌仍然是最常见的致病菌占44．2％，其次为凝固酶阴性葡萄球菌占21．2％。86例患者行超声心动图检查，其中61例发现赘生物（68．5％），住院病死率为10．1％，死亡及未愈者普遍表现为药物难以控制的心力衰竭及菌血症及脑血管意外等。结论基础病因中先天性心脏病呈明显上升趋势，风湿性心脏病明显下降，间歇性发热、贫血为主要临床表现，血培养阳性率不高，草绿色链球菌仍为主要致病菌，超声心动图为主要诊断依据。

Objective To improve the diagnosis and treatment of infective endocardits（IE） by exploring the causes, pathogenic microorganism, clinical characteristics and therapeutic results of patients with IE. Methods From January 2006 to January 2016,89 cases with IE in Ganzhou People＇s Hospital were collected,and the clinical charac- teristics were analyzed retrospectively. Results Among the IE patients ,40.5% had congenital heart diseases,33.7% had rheumatic heart diseases, 18.0% were post -PCI or operative endocarditis, and patients without basic cardiac diseases accounted for 7.9%. The most common clinical manifestations were fever （ 86.5% ）, followed by anemia （ 85.4% ）. The blood culture positive rate was 63.4%. Streptococci viridians were the most common causative organ- isms（44.2% ）, followed by coagulase - negative staphylococci （21.2%）. Eighty - six patients received echocardio- graphy examination ,vegetation was observed in 61 cases （68.5%）. The hospital mortality rate was 10. 1%, mostly due to refractory congestive heart failure and sepsis. Conclusion Congenital heart disease showed an upward trend, rheumatic heart disease decreased significantly. Intermittent fever, anemia are the main clinical manifestations. Blood culture positive rate is not high, Streptococcus viridians is the most common causative organism. Echocardiography is the main basis for the diagnosis.