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山东大学学报 (医学版) ›› 2020, Vol. 58 ›› Issue (6): 22-27.doi: 10.6040/j.issn.1671-7554.0.2019.1167

• 临床医学 • 上一篇    

某三甲医院80例感染性心内膜炎患者临床特征及内外科疗效比较

李杨1,2, 王中素1, 刘鲁祁3, 刘天起3, 王东3, 柳雪2, 王明华3, 侯应龙1   

  1. 1. 山东大学附属山东省千佛山医院心血管内科, 山东大学齐鲁医学院, 山东 济南 250014;2. 济南市第五人民医院重症医学科, 山东 济南 250022;3. 山东大学附属山东省千佛山医院心外科, 山东大学齐鲁医学院, 山东 济南 250014
  • 发布日期:2022-09-27
  • 通讯作者: 侯应龙. E-mail:houyinglong@sina.com王明华. E-mail:wangminghuaxw@163.com

Clinical features and comparison of medical and surgical efficacies of infective endocarditis in 80 patients in a tertiary hospital

LI Yang1,2, WANG Zhongsu1, LIU Luqi3, LIU Tianqi3, WANG Dong3, LIU Xue2, WANG Minghua3, HOU Yinglong1   

  1. 1. Department of Cardiovascular Medicine, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250014, Shandong, China;
    2. Department of Intensive Care Unit, The Fifth Peoples Hospital of Jinan, Jinan 250022, Shandong, China;
    3. Department of Cardiovascular Surgery, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250014, Shandong, China
  • Published:2022-09-27

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摘要： 目的 通过对感染性心内膜炎患者病因学、临床特征、并发症、预后等因素,结合相关文献分析感染性心内膜炎在本地区的疾病特征,为本地区感染性心内膜炎的诊治提供循证医学证据。 方法 回顾性分析2014年3月至2018年12月就诊的感染性心内膜炎患者80例的临床资料,包括患者人口学特征、基础心脏疾病、临床表现、合并症、病原菌组成、超声心动图表现及内外科治疗效果对比。 结果 人口学特征:感染性心内膜炎患者以中青年男性为主。临床表现及合并疾病:发热为最常见临床表现,最常见并发症为心力衰竭。病原微生物特点:血培养阳性率为57.5%,病原菌以革兰阳性球菌为主,其中金黄色葡萄球菌阳性率最高,草绿色链球菌次之。基础心脏病情况:90%患者合并基础心脏病,以主动脉瓣和二尖瓣非风湿性瓣膜病为主,30例患者进行过心脏手术。超声心动图表现:超声检查心脏赘生物阳性率高,主要附着在左心系统。内外科治疗效果及转归:内外科治疗组年龄以及发热、心脏杂音等临床表现和合并症并无显著差异,外科治疗较内科治疗预后较好。 结论 成人感染性心内膜炎患者以中青年男性为主,以发热为最常见临床表现,常见于心脏瓣膜病,以革兰阳性球菌感染为主,危害较大,外科治疗感染性心内膜炎效果好,患者预后较内科保守治疗具有显著优势,因此,满足外科手术条件的患者应积极进行外科手术治疗。

关键词: 感染性心内膜炎, 临床特征, 内科治疗, 外科治疗, 心脏疾病

Abstract: Objective To provide evidence for the diagnosis and treatment of infective endocarditis by analyzing the etiology, clinical features, complications and prognosis of patients treated in a local tertiary hospital. Methods Clinical data of 80 patients with infective endocarditis treated during March 2014 and December 2018 were retrospectively analyzed, including demographic characteristics, heart disease, clinical manifestations, comorbidities, pathogenic bacteria, and echocardiographic manifestations. The efficacies of medical and surgical treatments were compared. Results The majority of patients were young and middle-aged males. Fever was the most common clinical manifestation and heart failure was the most common complication. The positive rate of blood culture was 57.5%, and the pathogenic bacteria were mainly gram-positive coccus, especially staphylococcus aureus, followed by streptococcus aureus. Primary heart disease occurred in 90% of the patients, mainly non-rheumatic disease involved the aortic valve and mitral valve, and 30 patients underwent cardiac surgery. Ultrasound showed a high positive rate of cardiac vegetations, mainly attached to the left cardiac system. There were no significant differences in the treatment outcomes among patients with different ages, fever or heart murmur. Surgical treatment yielded better results than medical treatment. Conclusion The majority of adult with infective endocarditis are young and middle-aged males. Fever is the most common clinical manifestation, and heart valves are often involved. The major pathogenic microorganism is staphylococcus aureus. As surgical treatment is more effective than medical treatment, it is highly recommended for selected patients.

Key words: Infective endocarditis, Clinical feature, Medical treatment, Surgical treatment, Heart disease

中图分类号: 

  • R574
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