感染性心内膜炎182例临床分析  

Clinical analysis of 182 cases with infective endocarditis

作　　者：陈凡[1] 钱志勇[1] 彭志勇[1] 杨天伦[1] 张赛丹[1] 

机构地区：[1]中南大学湘雅医院,湖南长沙410008

出　　处：《中国感染控制杂志》2010年第2期100-102,84,共4页Chinese Journal of Infection Control

摘　　要：目的分析感染性心内膜炎(IE)的临床特点,提高诊治水平。方法回顾性分析182例IE患者的临床资料。结果 182例IE患者易患因素按比率依次为先天性心脏病(35.17%),二尖瓣脱垂并关闭不全(24.73%),风湿性心脏病(13.19%)等;最常见症状为发热(97.25%)和贫血(88.46%);2次血培养培养出同一病原菌中,最常见细菌为血液链球菌(11.76%),其次为金黄色葡萄球菌(11.03%);经胸超声心动图对心内膜赘生物的检出率为95.05%。119例经外科手术治疗者中,2例(1.68%)死亡;63例经内科治疗者中,6例(9.52%)死亡,原因主要为脑栓塞及急性心衰。结论近年来IE的易患因素与以往不同的是先天性心脏病比率增高,而风湿性心脏病比率下降;病原菌以链球菌属、葡萄球菌属为主,但呈多样化、复杂化特点;血培养的阳性率亟待提高;及时手术治疗可改善预后。Objective To analyze the clinical features of patients with infective endocarditis （IE） , so as to improve its diagnosis and treatment. Methods Clinical data of 182 patients with IE were analyzed retrospectively. Results The incidence of underlying heart diseases for IE in all patients were congenital heart diseases（35. 17%）, mitral valve prolapse with mitral insufficiency （24. 73%）, and rheumatic heart disease（ 13. 19%）. The most common clinical manifestations were fever （97. 25 %） and anemia（88. 46%） ; Streptococcus sanguis （11.76%） was the most common pathogen in blood culture followed by Staphylococcus aureus （11. 03%）. 173 （95.05%） cases were detected to have vegetation by the transthoracic echocardiography. Two of 119 patients （1.68 %） with surgical op- eration and 6 of 63 patients （9.52%） with internal medical treatment died, the primary causes for death were cerebral embolism and acute heart failure. Conclusion The risk factors for IE in recent years are different from those in the past years. The proportion of congenital heart diseases are increasing while that of the rheumatic heart disease is decreasing; Streptococcus spp. and Staphylococcus spp. are major pathogens of IE, the species of pathogens are characterized to be diversified and complex as well. The positive rate of blood culture needs to be improved. Surgical operation in time can improve the prognosis of IE.

关 键 词：心内膜炎 心脏病 感染 细菌 

分 类 号：R542.41[医药卫生—心血管疾病]