维持性血液透析并发感染性心内膜炎5例并文献复习  

ENDOCARDITIS IN PATIENTS ON MAINTENANCE HEMODIALYSIS:A REPORT OF FIVE CASES AND LITERATURE REVIEW

作　　者：张伟[1] 薛峰[2] 王淑娟[1] 邵乐平[1] 

机构地区：[1]青岛大学附属医院肾内科,山东青岛266003 [2]青岛大学附属医院麻醉科,山东青岛266003

出　　处：《青岛大学医学院学报》2016年第5期536-539,544,共5页Acta Academiae Medicinae Qingdao Universitatis

摘　　要：目的了解我国维持性血液透析并发感染性心内膜炎(HD-IE)病人的临床特点,为其临床治疗提供参考。方法检索近10余年国内报道的HD-IE病例20例,结合我院收治的5例,共25例病人,对其临床特点进行总结分析。结果 25例病人首发症状多为发热(22例),血培养阴性占50%;病原体阳性12例,以葡萄球菌感染为主;心内膜炎以累及二尖瓣为主。手术治疗2例。死亡13例,病死率52%。存活病人较死亡病人血液透析时间短、内瘘使用率低(P=0.022、0.006)。结论 HD-IE病人病死率高,葡萄球菌仍为HD-IE主要致病菌,血培养阴性率高,反复多次超声心动图检查对于确诊尤为重要。应合理使用敏感抗生素,及时取出深静脉置管,适时实施手术治疗,以降低病死率。Objective To investigate the clinical characteristics in patients undergoing maintenance hemodialysis complicated with infective endocarditis（HD-IE）and provide reference for its clinical therapy. Methods Retrieval of nearly 10 years of domestic reports about HD-IE,10 cases were collected,plus five of our own cases,a total of 25 cases being enrolled.The clinical characteristics of the patients were summarized and analyzed herein. Results In these 25 patients,the first symptom was much for fever in 22,and blood culture negative accounted for 50%.Pathogen positive was noted in 12 cases,mostly due to Staphylococcus,and endocarditis with mitral valve involvement was mainly reported.A surgery was done in two patients.The time of hemodialysis was shorter and the usage of arteriovenous fistula was lower in surviving patients versus those who died（P=0.022,0.006）.A total death in 13（52%）patients was reported. Conclusion The mortality of infective endocarditis is high in hemodialysis patients,and Staphylococcus remains the main pathogenic bacteria for the infection.Repeated echocardiography is even more important for its diagnosis.Reasonable use of sensitive antibiotics,pulling out the deep venous catheter without delay and timely surgical therapy should be conducted to reduce the mortality.

关 键 词：心内膜炎 细菌性 肾透析 病例报告 

分 类 号：R542.41[医药卫生—心血管疾病] R692[医药卫生—内科学]