您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

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

PDF (PC)

24

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
[1] Iung B, Duval X. Infective endocarditis: innovations in the management of an old disease[J]. Nat Rev Cardiol, 2019, 16(10): 623-635.
[2] Schirone L, Iaccarino A, Saade W, et al. Cerebrovascular complications and infective endocarditis: impact of available evidence on clinical outcome[J]. Biomed Res Int, 2018: 4109358. doi: 10.1155/2018/4109358.
[3] Sotero FD, Rosário M, Fonseca AC, et al. Neurological complications of infective endocarditis[J]. Curr Neurol Neurosci Rep, 2019,19(5): 23.
[4] Ortiz-Soriano V, Donaldson K, Du G, et al. Incidence and cost of acute kidney injury in hospitalized patients with infective endocarditis[J]. J Clin Med, 2019, 8(7):56.
[5] 张弯弯. 成人感染性心内膜炎患者短期预后影响因素分析[D]. 北京: 北京协和医学院,2018.
[6] 陈星伟, 刘亚欣, 于欢, 等. 阜外医院感染性心内膜炎300例临床特征分析[J]. 中国循环杂志,2018, 33(11): 1102-1107. CHEN Xingwei, LIU Yaxin, YU Huan, et al. Clinical characteristics, pathogenic distribution, treatment and prognosis of 300 patients with infective endocarditis hospitalized in Fuwai hospital[J]. Chinese Circulation Journal, 2018, 33(11): 1102-1107.
[7] 朱瑞, 张成鑫, 李鑫, 等. 202例感染性心内膜炎患者临床特征及手术时机分析[J]. 国际心血管病杂志,2018, 45(6): 358-362. ZHU Rui, ZHANG Chengxin, LI Xin, et al. A retrospective analysis of 202 cases of infective endocarditis about clinical features and operative opportunity[J].International Journal of Cardiovascular Disease, 2018, 45(6): 358-362.
[8] 谢京甫. 感染性心内膜炎216例的临床分析[D]. 南宁: 广西医科大学,2019.
[9] 朱丽莹. 135例感染性心内膜炎的临床特征及病原学分析[D]. 南京: 南京医科大学,2019.
[10] Jamil M, Sultan I, Gleason TG, et al. Infective endocarditis: trends, surgical outcomes, and controversies[J]. J Thorac Dis, 2019, 11(11): 4875-4885.
[11] Khan ZA, Hollenberg SM. Valvular heart disease in adults: infective endocarditis[J]. FP Essent, 2017, 457(6): 30-38.
[12] Marchetta S, Dulgheru R, Oury C, et al. Infective endocarditis: an emergency well too minimized[J]. Rev Med Liege, 2018, 73(5-6): 283-289.
[13] Daimon S, Mizuno Y, Fujii S, et al. Infective endocarditis-induced crescentic glomerulonephritis dramatically improved by plasmapheresis[J]. Am J Kidney Dis,1998, 32(2): 309-313.
[14] 游向东, 甄国平, 马亚洁. 以贫血为首发症状的亚急性感染性心内膜炎误诊1例分析[J]. 中国误诊学杂志, 2012, 12(4): 838.
[15] Panginikkod S, Gopalakrishnan V, Parikh M, et al. Janeway lesions: a painless manifestation of infective endocarditis[J]. J Gen Intern Med, 2019, 34(7): 1360-1361.
[16] Shimizu T, Tokuda Y. Oslers node[J]. BMJ Case Rep, 2013, 2013:bcr 2012007564. doi: 10.1136/bcr-2012-007564.
[17] Ramos Suárez A, Fernández Gasso ML. Roths spots and infective endocarditis[J]. Med Clin(Barc), 2019, 152(5): 29.
[18] Al Hennawi H, Mahdi EM, Memish ZA. Native valve Staphylococcus capitis infective endocarditis: a mini review[J]. Infection, 2019, 48(1): 3-5.
[19] Lehner A, Haas NA, Dietl M, et al. The risk of infective endocarditis following interventional pulmonary valve implantation: A meta-analysis[J]. J Cardiol, 2019, 74(3): 197-205.
[20] Delahaye F, De Gevigney G. Infective endocarditis and specific situations: Right heart, valve prosthesis, cardiac implantable electronic device[J]. Presse Med, 2019, 48(5): 549-555.
[21] Duval X, Millot S, Tubiana S, et al. Prevention of Infective endocarditis[J]. Presse Med, 2019, 48(5): 556-562.
[22] Knebel F, Frumkin D, Flachskampf FA. Infective Endocarditis[J]. Dtsch Med Wochenschr, 2019, 144(2): 114-127.
[23] Bor DH, Woolhandler S, Nardin R, et al. Infective endocarditis in the US.1998-2009: a nationwide study[J]. PLoS One, 2013, 8(3): e60033. doi: 10.1371/journal.pone.0060033.
[24] 叶飞, 张蓉, 周世文. 我院162例感染性心内膜炎患者的临床和病原学特征分析[J]. 中国药房, 2017, 28(29): 4076-4080. YE Fei, ZHANG Rong, ZHOU Shiwen. Analysis of clinical and pathogenic characteristics of 162 patients with infective endocarditis in our hospital[J]. China Pharmacy, 2017, 28(29): 4076-4080.
[25] Wong D, Rubinshtein R, Keynan Y. Alternative cardiac imaging modalities to echocardiography for the diagnosis of infective endocarditis[J]. Am J Cardiol, 2016, 118(9): 1410-1418.
[26] Holland TL, Baddour LM, Bayer AS, et al. Infective endocarditis[J]. Nat Rev Dis Primers, 2016, 9(2): 16059.
[27] Plicht B, Lind A, Erbel R. Infective endocarditis: New ESC guidelines 2015[J]. Internist(Berl), 2016, 57(7): 675-690.
[28] Molnar A, Sacui D, Manole S, et al. The value of transthoracic and transesophageal echocardiography for the diagnosis of the native aortic infective endocarditis valve complications: a case report and literature review[J]. Med Ultrason, 2016, 18(2): 253-256.
[29] Bin Abdulhak AA, Tleyjeh IM. Indications of surgery in infective endocarditis[J]. Curr Infect Dis Rep, 2017, 19(3): 10.
[30] Oliver L, Lepeule R, Moussafeur A, et al. Early surgery in infective endocarditis: Why should we wait?[J]. Arch Cardiovasc Dis, 2016, 109(12): 651-654.
[31] Hodges KE, Hussain ST, Stewart WJ, et al. Surgical management of infective endocarditis complicated by ischemic stroke[J]. J Card Surg, 2017, 32(1): 9-13.
[1] 巩性军，吴树明，张供，李守先，庞昕焱. 无顶冠状静脉窦综合征的诊断和外科治疗[J]. 山东大学学报(医学版), 2209, 47(6): 129-.
[2] 巩雨,高震,王虎清,杨晶雯,张桂莲,展淑琴,张茹,吴海琴. 4例继发性肥大性下橄榄核变性的临床及影像学特点[J]. 山东大学学报 (医学版), 2022, 60(5): 37-42.
[3] 王洲洋,江蓓,李宪花,甄军晖,杨向东,胡昭,刘广义,裴斐. 感染性心内膜炎、急性肾损伤伴PR3-ANCA阳性患者1例报道[J]. 山东大学学报 (医学版), 2022, 60(2): 60-64.
[4] 游雪婷,田兴松. 3 514例乳腺癌9年间临床及病理学特征分析[J]. 山东大学学报 (医学版), 2021, 59(1): 49-54.
[5] 雷宇,陆婧,顾佳颖,周登峰,李园园,卢桥发. 新型冠状病毒肺炎51例临床特征[J]. 山东大学学报 (医学版), 2020, 58(4): 65-70.
[6] 周生余,王春亭,张伟,王锡明,董亮. 山东省新型冠状病毒肺炎患者537例临床特征与救治效果[J]. 山东大学学报 (医学版), 2020, 58(3): 44-51.
[7] 崔亮亮,耿兴义,赵小冬,杨国樑,常彩云,赵梦娇,李战,王春荣,刘岚铮,阮师漫. 济南市现阶段新型冠状病毒肺炎的流行特征与思考[J]. 山东大学学报 (医学版), 2020, 58(3): 52-57.
[8] 张孝国,马艳,肖嘉安,张忠法. 济南市儿童新型冠状病毒肺炎的临床特征[J]. 山东大学学报 (医学版), 2020, 58(3): 62-64.
[9] 李劳冬,明莫瑜,蒋连强,蒋清柏,凌宙贵,吴昕. 气管血管球瘤1例并文献复习[J]. 山东大学学报 (医学版), 2018, 56(12): 111-113.
[10] 聂思月,王震,孙靖宇,刘杰,李娟,魏小娟,路春晓,吕兴龑,王淑云,孙玉萍. ANGPTL5在人胃癌组织中的表达及临床意义[J]. 山东大学学报（医学版）, 2017, 55(8): 61-65.
[11] 彭岳,冯振,谢厚耐,王晖,李猛,任万刚,刘通,彭忠民. 61例肺部多发病灶患者的外科治疗[J]. 山东大学学报（医学版）, 2017, 55(11): 42-46.
[12] 王光杰,俎树禄,张秀琳,徐祗顺,周春文,刘玉强,王绍勇. Von-Hippel-Lindau病并发肾癌2例[J]. 山东大学学报（医学版）, 2016, 54(2): 86-89.
[13] 姚冬雪, 赵琪, 秦成勇. miRNA-206在胃间质瘤组织中的表达及其临床意义[J]. 山东大学学报（医学版）, 2015, 53(12): 67-70.
[14] 孙莹, 于晶, 魏军民, 樊聪, 王秀问, 高鹏, 江立玉, 马婷婷. 35岁以下女性乳腺癌患者的临床病理特征[J]. 山东大学学报（医学版）, 2014, 52(7): 71-74.
[15] 张林1，张振江2，孟龙1，马伟1，杜贾军1. 恶性局灶性磨玻璃样肺结节的外科治疗[J]. 山东大学学报(医学版), 2013, 51(9): 84-87.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发