感染性心内膜炎老年患者的临床表现与死亡影响因素分析

Clinical manifestations of infective endocarditis in the elderly and influencing factors for deaths

目的探讨感染性心内膜炎老年患者的临床表现与死亡影响因素。方法回顾性分析2013年1月-2017年11月于中南大学湘雅医学院附属海口医院进行治疗的感染性心内膜炎老年患者137例的临床资料,观察患者生存情况,分析患者性别、年龄、发热情况、心脏栓塞、心脏瓣膜疾病等临床资料,归纳感染性心内膜炎老年患者死亡的影响因素。结果患者病变位置在左侧的比例最高,为109例,占79.56%,65.69%(90/137)的患者合并有基础性心脏病,在临床表现中出现栓塞的比例最高(86.86%);超声心动图结果中,以瓣膜穿孔的比例最高(27.01%),在瓣膜异常导致的并发症中,以肺动脉高压的比例最高(78.83%);血清学病原检查共培养分离病原菌81株,其中革兰阴性菌16株占19.75%,革兰阳性菌63株占77.78%,真菌2株占2.47%,以酿脓型链球菌和表皮葡萄球菌为主;心脏瓣膜类型,病原体培养结果阳性是感染性心内膜炎老年患者死亡的影响因素(P<0.05)。结论老年患者出现感染性心内膜炎所具有的临床特征具有一定的独特性,以酿脓型链球菌造成的感染为主,导致感染性心内膜炎老年患者死亡的因素有若干,需要进行具有针对性的干预。

OBJECTIVE To investigate the clinical manifestations of infective endocarditis in elderly patients and the influencing factors for death.METHODS The data of 137 elderly patients with infective endocarditis treated in the Haikou Hospital Affiliated to Xiangya Medical College of Central South University from Jan.2013 to Nov.2017 were retrospectively analyzed.The survival of the patients was observed.The clinical data of the patients such as gender,age,fever,heart embolism and heart valve disease were analyzed.Univariate analysis and multivariate analysis were used to summarize the independent risk factors for death in elderly patients with infective endocarditis.RESULTS The most common lesion location in the patients was on the left side,with 109 cases,accounting for 79.56%,and 65.69%of patients had a combination of basic heart disease.Embolization occurred as the most common clinical manifestation(86.86%).In the echocardiographic results,the proportion of perforation of the valve was the highest(27.01%).Among the complications caused by abnormal valve,the proportion of pulmonary hypertension was the highest(78.83%).Serological pathogens were co-cultured and 81 strains of pathogens were isolated,including 16 strains of Gram-negative bacteria,accounting for 19.75%,63 strains of Gram-positive bacteria,accounting for 77.78%,and 2 strains of fungi,accounting for 2.47%.Streptococcus pyogenes and Staphylococcus epidermidis were the major pathogenic bacteria.The type of cardiac valves and positive pathogen culture results were the influencing factors of death in elderly patients with infective endocarditis(P<0.05).CONCLUSION The clinical characteristics of infective endocarditis in elderly patients have certain uniqueness,mainly caused by Streptococcus pyogenes.There are a number of factors leading to the death of elderly patients with infectious endocarditis,and targeted interventions are needed.