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目的 探讨近年来感染性心内膜炎临床特点的变化。方法 回顾性分析我院1992 年1 月~2004年11月间61例感染性心内膜炎患者的临床资料,根据受累瓣膜种类(人工瓣或自然瓣)、血培养结果(阳性或阴性)、是否检出瓣膜赘生物将患者分为不同亚组,分析其对预后的影响。结果 风湿性心脏病(27.9%)、先天性心脏病(21.3%)、特发性二尖瓣脱垂及关闭不全(19.6%)分别居基础疾病的前3位。临床表现的发生率由高到低依次为贫血34例(55.7%)、肝脾肿大29例(47.5%)、不规则发热22例(36.1%)、血尿12例(19.7%)、脑血管意外10例(16.4%)。经超声心动图检查42例(68.9%)发现赘生物,细菌培养结果31 例为阳性。致病菌主要为链球菌(10株)、葡萄球菌(10株)、假单胞菌(3株)。常用的有效抗生素组合为去甲万古霉素+磷霉素+奈替米星(34.4%)、青霉素+氨基糖苷类(27.9%)。手术治疗22例(36.1%),住院期间死亡11 例(18.0%),主要死因为心力衰竭,其次为脑血管意外。不同亚组间住院病死率的差异无显著性(P>0.05)。结论 瓣膜种类、血培养结果及是否检出瓣膜赘生物对预后无明显影响,早期诊断、适时手术及内、外科联合治疗是治疗成功的关键。
Objective To explore the clinical features of infective endocarditis in recent years. Methods The clinical data of 61 patients with infective endocarditis from January 1992 to November 2004 in our hospital were retrospectively analyzed. According to the type of valve involved (artificial valve or natural valve), blood culture result (positive or negative) Whether the valve vegetation was detected divided the patients into different subgroups and analyzed their impact on the prognosis. Results Rheumatic heart disease (27.9%), congenital heart disease (21.3%), idiopathic mitral valve prolapse and insufficiency (19.6%) were among the top 3 underlying diseases, respectively. The highest incidence of clinical manifestations was anemia in 34 cases (55.7%), hepatosplenomegaly in 29 cases (47.5%), irregular fever in 22 cases (36.1%), hematuria in 12 cases (19.7%), cerebrovascular Accident in 10 cases (16.4%). Neoplasms were found in 42 cases (68.9%) by echocardiography, and 31 cases were positive for bacterial culture. Pathogenic bacteria are mainly Streptococcus (10 strains), Staphylococcus (10 strains), Pseudomonas (3 strains). The most commonly used effective antibiotic combinations are norvancomycin + fosfomycin + netilmycin (34.4%), penicillin + aminoglycosides (27.9%). Surgical treatment of 22 cases (36.1%), 11 cases died during hospitalization (18.0%), the main cause of death was heart failure, followed by cerebrovascular accidents. There was no significant difference in in-hospital mortality among different subgroups (P> 0.05). Conclusions The type of valve, blood culture results and the presence or absence of valve neoplasm have no significant effect on the prognosis. Early diagnosis, timely operation and combined treatment of internal and surgical treatment are the keys to successful treatment.