起搏器相关右心感染性心内膜炎的临床特点分析

Clinical characteristics of right-side infective endocarditis associated with cardiac pacemaker

目的探讨心脏起搏器相关右心感染性心内膜炎的临床特点。方法回顾性分析2009年1月至2015年8月首都医科大学附属北京安贞医院和北京大学人民医院收治的13例起搏器相关右心感染性心内膜炎患者的临床资料。依据装置置入或末次更换距发生感染性心内膜炎的时间,将患者分为早期组(<1年,7例)和晚期组(≥1年,6例),比较2组患者临床特征、治疗及转归的差异。结果 13例患者中出现全身症状者占92. 3%(12/13),出现局部症状者占38. 5%(5/13),心脏杂音占23. 1%(2/13)。血培养阳性者占76. 9%(10/13),葡萄球菌占30. 8%(4/13)。经胸超声心动图和/或经食管超声心动图检查均发现赘生物,赘生物大小为(14±8) mm。早期组和晚期组性别、年龄、起搏器置入次数、易感因素、临床症状及体征、实验室检查结果、血培养阳性率、赘生物大小比较差异均无统计学意义(均P> 0. 05)。所有患者均完全清除原有装置。经静脉途径拔除电极导线的6例患者赘生物平均大小为(15±8) mm,经外科开胸拔除的7例患者赘生物平均大小为(14±8) mm,差异无统计学意义(P=0. 860)。所有患者均痊愈出院,至少随访36个月,未发现起搏器相关感染、死亡等不良事件。结论葡萄球菌是起搏器相关右心感染性心内膜炎的常见致病菌。电极导线拔除术是安全有效的治疗方法。

Objective To identify the clinical features of right-side infective endocarditis associated with pacemaker. Methods A retrospective analysis was undertaken in 13 patients diagnosed of right-side infective endocarditis associated with pacemaker who were admitted to Beijing Anzhen Hospital,Capital Medical University and Peking University People’ s Hospital between January 2009 and August 2015. According to the duration between onset and pacemaker implantation,the patients were divided into early group( < 1 year,n = 7) and late group( ≥1 year,n = 6). Clinical features,therapeutic choice and prognosis were analyzed. Results Systemic symptoms occurred in 92. 3%( 12/13) and local symptoms occurred in 38. 5%( 5/13) of the patients. Cardiac murmurs were found in 23. 1%( 2/13). Positive blood culture was obtained in 76. 9%( 10/13) and staphylococcal accounted for 30. 8%( 4/13). Transthoracic/transoesophageal echocardiography demonstrated vegetations in all patients and the mean size of vegetations was( 14 ± 8) mm. There was no significant difference of gender,age,times of pacemaker implantation,predisposing factors,clinical symptoms and signs,laboratory results,blood culture positive rate and size of vegetations between the early group and late group( all P > 0. 05). Two techniques were used for cardiac device removal: transvenous removal( n = 6) and surgical removal with extracorporeal circulation( n = 7);the mean size of vegetations showed no significant difference between transvenous and surgical removal[( 15 ± 8) mm vs( 14 ± 8) mm]( P = 0. 860). All patients were cured. No death or pacemaker-related infection happened during the follow-up of at least 36 months. Conclusions Staphylococcal is the main pathogenic bacteria of right-side infective endocarditis associated with pacemaker. Transvenous or surgical lead extraction is safe and effective.