左心感染性心内膜炎患者的诊疗一例  

Diagnosis and treatment of left-sided infective endocarditis:a case report

作　　者：弓清梅[1] 薛彦[1] 王芳[1] 李敏[1] Gong Qingmei;Xue Yan;Wang Fang;Li Min(Intensive Care Unit,Shanxi Provincial People′s Hospital,Taiyuan 030012,China)

机构地区：[1]山西省人民医院重症医学病房,太原030012

出　　处：《中华重症医学电子杂志》2018年第4期376-378,共3页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

摘　　要：此例患者急性心肌梗死溶栓术后,术后间断发热。超声显示二尖瓣前叶赘生物(6 mm)形成。考虑左心感染性心内膜炎,给予万古霉素联合哌拉西林/他唑巴坦治疗10 d后,出现急性肾功能损伤。遂调整方案为达托霉素[剂量选择8 mg/(kg·d)],血肌酐持续高,故调整为8 mg/(kg·q48 h),进一步调整为6 mg/(kg·q48 h)。在6周的达托霉素治疗过程中,患者未再有发热,红细胞沉降率(ESR)下降,肾功能逐渐正常,同时心脏彩超显示赘生物进一步减小,显示治疗有效。This patient had intermittent fever with acute myocardial infarction after thrombolytic therapy. The ultrasound showed the formation of mitral valve anterior excrescence （6 mm） . Acute kidney injury occurred 10 days after the treatment of Vancomycin combined with Piperacillin / Tazobactam for the consideration of the left-sided infective endocarditis. In the beginning, our adjustment program was the treatment of Daptomycin [dose 8 mg / （kg·d）], but serum creatinine （Scr） continued to rise, so we adjusted the dose of 8 mg / kg·q48 h, further adjusted the dose of 6 mg / kg·q48 h. Dring the treatment with Daptomycin of 6 weeks, no further fever in patient and the erythrocyte sedimentation rate （ESR） decreased, the kidney function gradually turned to normal while the echocardiography showed the excrescence further reduced , this treatment was effective.

关 键 词：左心感染性心内膜炎 急性心肌梗死 急性肾功能损伤 血肌酐 达托霉素 

分 类 号：R542.41[医药卫生—心血管疾病]