风湿性与非风湿性瓣膜性心脏病所致感染性心内膜炎的流行病学变化及不同治疗策略疗效分析  

Epidemiological Changes,Therapeutic Strategies,Curative Effect Analysis of Infectious Endocarditis Caused by Rheumatic and Non-rheumatic Valvular Heart Disease

作　　者：王晶晶 张继佳[2] 王超 WANG Jing-jing;ZHANG Ji-jia;WANG Chao

机构地区：[1]河南省人民医院省直第一医院,河南郑州450003 [2]郑州大学第二附属医院,河南郑州450014

出　　处：《风湿病与关节炎》2018年第12期20-23,共4页Rheumatism and Arthritis

摘　　要：目的:分析风湿性与非风湿性瓣膜性心脏病所致感染性心内膜炎的流行病学变化,探讨不同治疗策略疗效及预后的差异。方法:选取121例风湿性与非风湿性瓣膜性心脏病所致感染性心内膜炎患者,分析其临床资料,对其病原学特点及疗效预后等进行统计分析。结果:①风湿性瓣膜性心脏病43例,非风湿性瓣膜性心脏病78例。②血培养病原菌以金黄色葡萄球菌(48株)及A族乙型溶血性链球菌(45株)为主。③不同治疗策略下,风湿性与非风湿性瓣膜性心脏病组临床治愈率及半年死亡率比较,差异均有统计学意义(P <0.05);不同疾病组内,单纯药物治疗组和药物+手术治疗组临床治愈率及半年死亡率比较,差异均有统计学意义(P <0.05)。结论:瓣膜性心脏病所致感染性心内膜炎病原菌以葡萄球菌及链球菌为主,菌种呈多样化;相较非风湿性瓣膜性心脏病,风湿性瓣膜性心脏病的临床治愈率更低,半年死亡率更高;无论是风湿性或非风湿性瓣膜性心脏病,积极的手术干预疗效较好,半年死亡率低于单纯内科药物治疗。Objective:To analyze the epidemiological changes of infectious endocarditis caused by rheumatic and non-rheumatic valvular heart disease,and to explore different therapeutic strategies,curative effect and prognosis.Methods:One hundred and twenty-one patients with infectious endocarditis caused by rheumatic valvular heart disease and non-rheumatic valvular heart disease were selected and their clinical data were analyzed.Their etiological characteristics,curative effect and prognosis were analyzed.Results:①Rheumatic valvular heart disease43cases and non-rheumatic valvular heart disease78cases.②Staphylococcus aureus(48strains)and Group A Streptococcus(45strains)were the main pathogens in blood culture.③Under different treatment strategies,the clinical cure rate and half-year mortality rate of rheumatic valvular heart disease and non-rheumatic valvular heart disease were significantly different(P<0.05).In different disease groups,the clinical cure rate and half-year mortality rate with single drug and drug combining operation were statistically significant(P<0.05).Conclusion:Staphylococcus and Streptococcus are the main pathogens of infectious endocarditis caused by valvular heart disease.Compared with non-rheumatic valvular heart disease,the clinical cure rate of rheumatic valvular heart disease is lower and the half-year mortality rate is higher.Whether rheumatic valvular heart disease or non-rheumatic valvular heart disease,active surgical intervention has a better effect,and the half-year mortality rate is lower than that treated with drug alone.

关 键 词：感染性心内膜炎 瓣膜性心脏病 风湿性 非风湿性 赘生物 病原菌 

分 类 号：R541[医药卫生—心血管疾病] R542.41[医药卫生—内科学]