感染性心内膜炎及并发症的超声心动图诊断与鉴别诊断  

Echocardiography in the diagnosis and differentition diagnosis of infective endocarditis

作　　者：杨燕[1] 梁春香[1] 韦修莹[1] 孙梦语[1] 

机构地区：[1]济南军区总医院心血管内科,山东济南250031

出　　处：《实用医药杂志》2012年第5期385-387,共3页Practical Journal of Medicine & Pharmacy

摘　　要：目的总结和探讨超声心动图对感染性心内膜炎(infective endocarditis,IE)及其并发症的诊断价值和鉴别诊断。方法分析28例经临床治疗或手术确诊的IE患者的超声心动图及临床表现。结果①5例(17%)无基础心脏病变,23例(83%)患者存在各种基础心脏病变,包括风湿性心脏病7例、先天性心脏病13例、老年瓣膜退行性改变3例;②超声对瓣膜赘生物的检出率为100%,赘生物附着于主动脉瓣最多见(19例)、其次为二尖瓣(15例),联合瓣膜病变(5例);超声对瓣膜损伤的检出率为100%;超声对IE并发症如人工瓣周漏、脱垂、穿孔的检出率分别为100%、100%、35%。结论超声可准确诊断心脏基础病变,客观显示大多数IE患者瓣膜赘生物大小、数量、位置及其所造成的心脏血流动力(瓣膜关闭不全等并发症)学改变,是协助临床明确诊断、及时治疗的首选检查方法。但对联合瓣膜病变、瓣叶穿孔及老年IE赘生物的判断能力尚有待改善。Objective To evaluate the clinical value of echocardiography in the diagnosis of infective endocarditis（IE）,as well its differential diagnosis.Methods The 38 cases of infective endocarditis were rewiewed based on the clinical and echocardiographic data.Results 1） 5 cases（17%） had no primary heart diseases;23 cases（83%） of atypical IE had developed on the basis of primary heart diseases,including 7 rheumatic heart disease,13 congenital heart disease and 3 degenerative heart valve disease.2） the detection rate of vegetations by echocardiography was about 100%,in which the aortic valve vegetations were predominant（19 cases）,the valvula bicuspidalis vegetations were at the second（15 cases）,and combined valvula lesion of 5 cases.The diagnosis accordance rate of the valve injury was 100%.In other complications such as prosthetic valve leakage,prolapse,perforation the detection rate was 100%,100%,35%.Conclusion Echocardiography could accurately assess the primary heart diseases and the complications like vegetation size,number and attachment location,damage of valve in the majority of patients with infective endocarditis,thus it is the first choice of helping confirmed diagnosis and timely performing treatment.But the assessment ability for the valve perforation and combined valvular disease should be further improved,and more attentively to notice the senile IE patients.

关 键 词：感染性心内膜炎 超声心动图 并发症 

分 类 号：R542.41[医药卫生—心血管疾病] R540.45[医药卫生—内科学]