感染性心内膜炎伴脓毒性肺栓塞的临床特征分析  

Clinical analysis of infective endocarditis with septic pulmonary embolism

作　　者：武静[1] 张庆宪[1] 邢丽华[1] Wu Jing;Zhang Qingxian;Xing Lihua(Department of Respiratory, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China)

机构地区：[1]郑州大学第一附属医院呼吸内科,郑州450052

出　　处：《中华医学杂志》2019年第10期775-777,共3页National Medical Journal of China

摘　　要：目的分析感染性心内膜炎(IE)伴脓毒性肺栓塞的临床特征。方法回顾性分析2010年1月-2017年6月郑州大学第一附属医院16例IE伴脓毒性肺栓塞患者的临床表现和血培养、超声心动图、胸部CT检查结果及诊治经过,总结其临床特征。结果16例患者中男4例,女12例,年龄(29.5±9.7)岁;12例有先天性心脏病;主要临床表现为发热、咳嗽、呼吸困难、咯血。血培养阳性7例,其中6例病原菌为链球菌属。超声心动图均发现心脏赘生物,均为右心赘生物。胸部CT特点为肺部多发性病变,主要表现为多发结节影及小斑片影。16例初期均误诊为肺炎。患者均静脉使用抗菌药物治疗,13例接受心脏手术治疗,6例治愈,8例好转,2例自动出院。结论IE伴脓毒性肺栓塞容易误诊,对于发热伴肺部多发阴影者需考虑到右心IE的可能。超声心动图发现心脏赘生物可明确诊断,必要时可多次心脏彩超检查。在抗感染基础上尽早手术治疗预后良好。Objective To analyze the clinical features of infective endocarditis with septic pulmonary embolism, and to improve the diagnosis and treatment of the disease. Methods Retrospective analysis of clinical manifestations, blood culture, echocardiography, chest CT and diagnosis and treatment of 16 patients with infective endocarditis and septic pulmonary embolism in the First Affiliated Hospital of Zhengzhou University from January 2010 to June 2017 was carried out, and the clinical features of the disease were summarized. Results Out of the 16 patients, 4 were males and 12 were females, aged (29.5±9.7) years old, 12 patients were with congenital heart disease. The main clinical manifestations were fever, cough, dyspnea, hemoptysis. There were 7 cases with positive blood culture, and 6 of them were Streptococcus. Echocardiography revealed cardiac vegetations, and all were from right heart. Chest CT was characterized by multiple pulmonary lesions, mainly characterized by multiple nodules and small patch shadows. All 16 patients were initially misdiagnosed as pneumonia. All patients were treated with antibiotics intravenously, 13 patients underwent cardiac surgery, 6 patients were cured, 8 patients improved, and 2 patients were discharged automatically. Conclusions Infective endocarditis with septic pulmonary embolism is easily misdiagnosed. In patients with fever and multiple shadows in the lungs, the possibility of right heart infective endocarditis should be considered. The diagnosis can be confirmed once cardiac vegetations are found by echocardiography, and repeated echocardiographic examinations can be performed if necessary. The prognosis of patients treated with surgery as early as possible on the basis of anti-infection is good.

关 键 词：心内膜炎 感染 肺栓塞 

分 类 号：R542.41[医药卫生—心血管疾病] R563.5[医药卫生—内科学]