感染性心内膜炎继发脑出血误诊分析  

Analysis of Misdiagnosis of Cerebral Hemorrhage Secondary to Infective Endocarditis

作　　者：李东 漆建[2] 刘洪军[2] 陈春宝 LI Dong;QI Jian;LIU Hong-jun;CHEN Chun-bao(North Sichuan Medical College Graduate School,Nanchong,Sichuan 637000,China;Department of Neurosurgery,the Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,China)

机构地区：[1]川北医学院研究生院,四川南充637000 [2]川北医学院附属医院神经外科,四川南充637000

出　　处：《临床误诊误治》2023年第1期33-36,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨感染性心内膜炎继发脑出血的临床特征及诊疗经验,并总结防范误诊措施。方法回顾性分析2019年7月—2022年7月收治曾误诊的5例感染性心内膜炎继发脑出血临床资料。结果本组男4例、女1例,年龄40~65岁。5例均以不明原因发热就诊,4例有典型皮肤改变,3例有下肢水肿,2例有瓣膜置换术病史,2例发病前有上呼吸道感染史;分别误诊为肺部感染、上呼吸道感染、脓毒症、过敏性紫癜、免疫性血小板减少症;误诊时间3 d~4个月。结合病史、超声心动图、血培养及新发栓塞事件确诊为感染性心内膜炎继发脑出血;确诊后经抗感染等治疗3例好转出院,2例出现全身多器官功能衰竭。结论感染性心内膜炎继发脑出血时缺乏特异性临床表现,误诊率高,临床医师应加强对本病的认识,在脑出血前及时明确诊断,降低误诊率。Objective To investigate the clinical characteristics,diagnosis and treatment experience of cerebral hemorrhage secondary to infective endocarditis,and to summarize preventive measures for misdiagnosis.Methods The clinical data of 5 patients with intracerebral hemorrhage secondary to infective endocarditis misdiagnosed who were admitted from July 2019 to July 2022 were retrospectively analyzed.Results There were 4 males and 1 female,aged 40-65 years.All the 5 patients presented with fever of unknown cause,4 had typical skin changes,3 had lower limb edema,2 had valve replacement history,and 2 had upper respiratory tract infection before onset.They were misdiagnosed as pulmonary infection,upper respiratory tract infection,sepsis,allergic purpura,immune thrombocytopenia,respectively.The duration of misdiagnosis was 3 d-4 months.Combined with history,echocardiography,blood culture,and new embolism events,the patients were diagnosed with cerebral hemorrhage secondary to infective endocarditis.After diagnosis,3 cases were discharged after anti-infection treatment,and 2 cases developed systemic multiple organ failure.Conclusion There is a lack of specific clinical manifestations in cerebral hemorrhage secondary to infective endocarditis,and the misdiagnosis rate is high.Clinicians should strengthen the understanding of this disease,make a clear diagnosis in time before cerebral hemorrhage,and reduce the misdiagnosis rate.

关 键 词：感染性心内膜炎 脑出血 误诊 上呼吸道感染 脓毒症 过敏性紫癜 

分 类 号：R742.7[医药卫生—神经病学与精神病学]