经胸超声心动图行心脏各切面扫查对感染性心内膜炎患者的临床诊疗价值分析  

Evaluation of clinical diagnosis and treatment of patients with infective endocarditis by transthoracic echocardiography

作　　者：刘玉森[1] 李拓[1] 张俊鹏[1] 李夏[1] 陈道芒 LIU Yu-sen;LI Tuo;ZHANG Jun-peng;LI Xia;CHEN Dao-mang(The First Affiliated Hospital of Nanyang Medical College, Nanyang, Henan 473058, Chin)

机构地区：[1]南阳医学高等专科学校第一附属医院超声诊断科,河南南阳473058

出　　处：《中华医院感染学杂志》2018年第7期1020-1023,共4页Chinese Journal of Nosocomiology

基　　金：河南省自然科学基金项目(142102310129)

摘　　要：目的探讨经胸超声心动图行心脏各切面扫查对感染性心内膜炎患者临床诊疗价值。方法选取2016年2月-2017年2月于医院就诊并接受超声检查诊断为感染性心内膜炎(IE)的229例患者为研究对象,所有患者入院后均行血培养检查,患者入院后两天内均行超声心动图检查,对患者的心脏各切面进行常规扫查;观察分析患者的心脏结构、心脏功能和血流情况,了解患者心脏室壁及瓣膜的运动情况;观察患者心脏内的赘生物的数量和大小,赘生物所在的部位、活动情况,及瓣膜的返流情况。结果经超声心动图行心脏各切面扫查诊断为IE的229例患者中,超声检查阳性率为96.1%(220/229),高于血培养检查阳性率68.1%(156/229)(χ2=5.273,P=0.036);有176例患者接受了手术治疗,接受手术治疗患者的赘生物所在部位及大小与超声心动图检查结果一致的共176例,准确率为100.0%;220例患者在超声检查中发现了赘生物,赘生物部位以主动脉瓣121例占55.0%为主,其次为二尖瓣前叶或者后叶57例占25.9%;超声检查发现,大多数的赘生物都有很大的活动度,其一般会随着患者心脏的搏动而出现飘动的现象。结论通过使用经胸超声心动图检查可以准确快速地发现赘生物,并能对其位置、大小做准确判断,对于早期诊断、治疗及预后有重要意义。OBJECTIVE To evaluate the clinical value of transthoracic echocardiography in the clinical diagnosis and treatment of infective endocarditis（IE）.METHODS A total of 229 cases of IE patients diagnosed by ultrasound diagnosis in our hospital from Feb.2016 to Feb.2017 were selected.All patients were followed by blood culture.Patients underwent echocardiography within two days of admission,and routine examination of the patient＇s heart sections was performed.The heart structure,cardiac function and blood flow of the patients were observed and analyzed,and the motions of heart wall and heart valve were observed.The number and size of the vegetation in the heart,the location and activity of the vegetations,and the regurgitation of the valve were observed.RESULTS Among 229 cases of IE patients diagnosed by ultrasound diagnosis of heart sections,the positive rate of ultrasound diagnosis was 96.1%（220/229）,which was significantly higher than 68.1%（156/229）of blood culture（χ~2=5.273,P=0.036）.Totally 176 patients underwent surgical treatment,and 176 cases in which the location and size of the vegetation were in accordance with the results of echocardiography,and the accuracy rate reached 100.0%.Totally 220 patients found the vegetation in the ultrasound examination,which was mainly located in aortic vaives（121 cases,55.0%）and the mitral valve anterior or posterior leaves（57 cases,25.9%）.Ultrasound findings showed that most of the vegetation had a large degree of activity,and they were usually fluttering along with the heart beat of the patients.CONCLUSIONThe use of transthoracic echocardiography can accurately and quickly find the vegetation,and make a accurate judgement of its position and size,which is of great significance for the early diagnosis,treatment and prognosis.

关 键 词：超声心动图 感染性心内膜炎 临床价值 

分 类 号：R445[医药卫生—影像医学与核医学]