妊娠合并右心感染性心内膜炎的临床特征及母婴结局的文献分析

Clinical features and maternal and infant outcomes of right-sided infective endocarditis during pregnancy:a case report and literature review

目的探讨妊娠合并右心感染性心内膜炎的临床特征、处理策略和母婴结局,为疾病的诊断和治疗提供理论依据。方法在中国知网、万方数据库、维普网、中国生物医学文献服务系统、PubMed、OVID、EMbase、ScienceDirect数据库检索相关文献,提取临床资料,分析妊娠合并右心感染性心内膜炎的临床表现、危险因素、赘生物位置、血培养结果、治疗策略和母婴结局等。结果纳入15篇文献,共18例患者。患者年龄为(27.7±4.8)岁,发病孕周为(27.8±6.9)周。发热(14例)、咳嗽(12例)、贫血(8例)、气短或呼吸困难(8例)是最常见的症状。心脏听诊时7例可闻及杂音,其中6例为收缩期杂音,1例未明确杂音类型,5例明确心脏听诊无杂音。9例合并肺栓塞和5例合并心力衰竭。危险因素主要为先天性心脏病(10/18)和静脉药瘾史(6/18)。赘生物附着位置以三尖瓣居多(10/18),其次为肺动脉瓣(4/18)。血培养阳性率高(15/16),主要包括葡萄球菌(9/15)及链球菌(3/15)。处理策略上,多以剖宫产适时终止妊娠,针对心内膜炎方面,在应用足量足疗程抗生素的基础上,11例患者行心脏手术,术式主要包括赘生物清除术、瓣膜修复或置换术以及先天性心脏病的手术等,根据患者的孕周、病情和心肺功能等具体情况决定手术在终止妊娠之前、之后或同期进行。18例患者全部存活,新生儿1例死亡(妊娠28周时行剖宫产分娩,因重度窒息死亡)。产妇随访情况基本良好。结论妊娠合并右心感染性心内膜炎临床少见且病情复杂,需及早诊断并实施个体化治疗方案。给予足量足疗程抗生素、选择合适的手术方案以及终止妊娠的时机,对于母婴结局具有重要意义。

Objective To investigate the clinical features,treatment strategies,and maternal and infant outcomes of pregnancy complicated by right-sided infective endocarditis(RSIE)to provide evidence for clinical management.Methods By searching literature on RSIE during pregnancy from the databases of CNKI,Wanfang Database,VIP,CBM,PubMed,OVID,EMbase and ScienceDirect,relevant information were collected to analyze the clinical manifestations,risk factors,positions of intracardiac vegetations,results of blood culture,treatment strategies and maternal and infant outcomes of RSIE.Results A total of 15 articles were retrieved,involving 18 infected gravidas with the average age of(27.7±4.8)years and average gestational age at onset of(27.8±6.9)weeks.Fever(n=14),cough(n=12),anemia(n=8)and shortness of breath or dyspnea(n=8)were the common symptoms.Cardiac murmurs were detected on auscultation in seven cases,of which six were systolic murmurs and one was unspecified.Heart sounds of five cases were clear on auscultation without any murmurs.Nine cases were complicated by pulmonary embolism and five by heart failure.The major risk factors were congenital heart diseases(10/18)and intravenous drug abuse(6/18).Vegetations were commonly seen on the tricuspid valves(10/18),followed by the pulmonary valves(4/18).The rate of positive blood culture was high(15/16)with Staphylococcus(9/15)and Streptococcus(3/15)being the primary pathogens.Most pregnancies were timely ended by cesarean section.Apart from receiving fundamental antibiotic therapy for infective endocarditis,11 patients underwent cardiac surgery,including vegetation removal,valve repair or replacement and surgery for congenital heart diseases,before or after pregnancy or during cesarean section based on their gestational age,condition,and cardiopulmonary function.There was no maternal death,but one neonatal death was reported due to severe asphyxia following cesarean section at 28 weeks.Maternal and neonatal outcomes were good during follow-up.Conclusions Pregnancy complicated by RSIE is rare and complex,requiring early diagnosis and individualized treatment.Adequate and full-course antibiotic therapy,appropriate surgical procedures and timely termination are of great importance for improving maternal and infant outcomes.