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目的分析感染性心内膜炎(IE)临床特点的演变趋势。方法回顾性分析1987年7月至2007年7月北京大学第三医院确诊的68例IE患者病例资料,比较前后10年的临床表现。结果68例患者中有基础心脏病者61例(89.7%),发热67例(98.5%),心脏杂音62例(91.2%);经胸超声心动图赘生物检出率为83.8%(57/68),血培养阳性率60.3%(41/68);外科手术治愈率19.1%;总体治愈率66.7%(52/68)。前后10年比较:近10年发病年龄推后[(36.7±12.7)岁对(44.4±18.6)岁,P<0.05];基础心脏病中先天性心脏病和风湿性心脏病比例减少(分别44.4%对24.4%和33.3%对17.1%,P<0.05),而瓣膜松弛症的比例增加(0对29.3%);心力衰竭、器官或血管栓塞发生率在近10年显著下降(77.8%对46.3%和44.4%对17.1%,P<0.05)。结论IE临床表现复杂,发热、心脏杂音仍为主要症状;近10年发病年龄推后;及时、反复血培养和超声心动图检查可提高确诊率,规范、充分的抗生素治疗和及时、合理的手术治疗可降低病死率。
Objective To analyze the evolution trend of clinical features of infective endocarditis (IE). Methods The clinical data of 68 patients with IE diagnosed at Peking University Third Hospital from July 1987 to July 2007 were retrospectively analyzed. The clinical manifestations of 10 years before and after comparison were compared. Results Among the 68 patients, 61 (89.7%) had basic heart disease, 67 (98.5%) had fever and 62 (91.2%) had heart murmur. The detection rate of neoplasm by transthoracic echocardiography was 83.8% (57 / 68). The positive rate of blood culture was 60.3% (41/68). Surgical cure rate was 19.1%. The overall cure rate was 66.7% (52/68). P <0.05). The incidence of congenital heart disease and rheumatic heart disease in basic heart disease decreased (44.4 ± 18.6 years, respectively, 44.4 ± 18.6 years old, respectively; 44.4 ± 18.6 years old, respectively % Versus 24.4% and 33.3% vs 17.1%, respectively), while the proportion of valvular relaxations increased (0 vs 29.3%); the incidence of heart failure, organ or vascular emboli decreased significantly in the recent 10 years (77.8% vs. 46.3 % And 44.4% vs 17.1%, P <0.05). Conclusions The clinical manifestations of IE are complex, fever and heart murmur are still the main symptoms; the age of onset in the past 10 years is delayed; timely and repeated blood culture and echocardiography can improve the diagnosis rate, standard and adequate antibiotic treatment and timely and reasonable operation Treatment can reduce mortality.