感染性心内膜炎16例误诊分析  

Analysis of misdiagnosis of 16 cases of infective endocarditis

作　　者：齐文旗 陈凉[1] 葛勤敏[1] 边帆[2] QI Wenqi;CHEN Liang;GE Qinmin;BIAN Fan(Department of Emergency,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai,200092,China;Department of Nephrology,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine)

机构地区：[1]上海交通大学医学院附属新华医院急诊科,上海200092 [2]上海交通大学医学院附属新华医院肾内科

出　　处：《临床急诊杂志》2021年第4期275-278,共4页Journal of Clinical Emergency

摘　　要：目的:分析感染性心内膜炎(IE)的临床特点及误诊原因、防范措施。方法:对16例曾误诊的感染性心内膜炎的临床资料进行回顾性分析。结果:本组确诊前出现发热16例,咳嗽、咳痰等呼吸道症状10例,胸闷、气促5例,腹泻1例,头痛1例,腹痛1例;16例心脏听诊均可闻及心脏杂音。因发热、咳嗽、咳痰、胸闷、气促、腹痛、腹泻、头痛等被误诊为肺部感染8例,肺部感染伴心功能不全5例,胃肠炎1例,脑梗死合并肺部感染1例,脾脓肿1例。本组平均误诊时间9.4 d。本组按误诊疾病治疗后均效果不佳,后根据病史、临床表现、体格检查及心脏超声检查结果明确诊断IE,14例行手术治疗,2例为药物治疗,治疗2~3周后患者症状好转、生命体征平稳出院,门诊随访6~12个月,14例均预后好,2例死亡。结论:感染性心内膜炎临床表现多样,容易漏诊误诊。临床接诊发热患者特别是原因不明发热时,应加强心脏查体有助于诊断此病。加强病史询问及查体、及时完善相关检查是避免误诊误治的关键。Objective: To analyze the clinical characteristics, causes of misdiagnosis and preventive measures of infective endocarditis(IE). Methods: Clinical data of 16 misdiagnosed cases of IE were analyzed retrospectively. Results: Before the definite diagnosis, there were 16 cases of fever, 10 cases of respiratory symptoms such as cough and expectoration, 5 cases of chest tightness and shortness of breath, 1 case of diarrhea, 1 case of headache, 1 case of abdominal pain, and 16 cases of heart murmurs during auscultation. Due to symptoms of fever, cough, expectoration, chest distress, shortness of breath, abdominal pain, diarrhea and headache, 8 cases were misdiagnosed as pneumonia, 5 cases as pneumonia with heart failure, 1 case as gastroenteritis, 1 case as cerebral infarction with pneumonia, 1 case as splenic abscess. The average duration of misdiagnosis was 9.4 days. The patients were treated according to misdiagnosed diseases and the results were not good. Then according to their medical history, clinical manifestations, physical examination and echocardiography results, patients were definitely diagnosed as IE, of which, 14 patients were treated by surgery, 2 patients were treated by drugs. After 2 to 3 weeks of treatment, the symptoms of the patients were relieved and the vital signs were discharged smoothly. The outpatient follow-up was 6 to 12 months. In total, 14 patients had a good prognosis and 2 died. Conclusion: The clinical manifestations of infective endocarditis are varied and could be misdiagnosed easily. In the clinical diagnosis of fever patients, especially those with unknown causes, it is necessary to strengthen the physical examination of the heart to help diagnose the disease. The key to avoiding misdiagnosis and mistreatment is to appreciate medical history inquiry and physical examination and to complete relevant medical examinations in time.

关 键 词：感染性心内膜炎 误诊 发热 

分 类 号：R542.41[医药卫生—心血管疾病]