目的 探索感染性心内膜炎的临床特点及治疗结果,以提高其临床疗效。 方法 回顾性分析2008年1月至2009年12月北京阜外心血管病医院104例感染性心内膜炎患者的临床资料,其中男64例、女40例,平均年龄40.8岁,血培养阳性47例(45.2%)。超声心动图检查提示:90例(86.5%)心脏瓣膜或流出道有赘生物,赘生物位于主动脉瓣36例,二尖瓣32例,三尖瓣11例,右心室流出道3例,多个瓣膜6例。据血培养结果行药物或外科手术治疗,术前及术后应用敏感抗生素治疗。 结果 全组33例行内科药物治疗,病死率为33.3% (11/33);72例行外科手术清除赘生物及进行心脏基础病变治疗,病死率为4.1% (3/72)。死亡原因1例为低心排血量,1例感染,1例脑梗塞。赘生物培养均为阴性。体外循环时间(117.5±63.3) min,主动脉阻断时间(82.7±44.8) min。总的中位住院时间30.9 d,术后住院时间13 (6~41) d。术后有3例感染再发,2例因为瓣周漏引起感染再发,1例行瓣膜成形术后感染再发。 结论 基础心脏病仍是感染性心内膜炎常见病因。早期、有效、规律的抗生素治疗仍是治疗基础,及时的外科治疗可降低病死率。
Citation:
张岩,孙寒松,胡盛寿,潘世伟,唐跃,谢涌泉,王巍,许建屏. 感染性心内膜炎104例的临床分析. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(5): 604-606. doi: 10.7507/1007-4848.20130184
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Moreillon P, Que YA. Infective endocarditis. Lancet, 2004, 363:139-149.
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Hoen B, Alla F, Selton-Suty C, et al. Changing profile of infective endocarditis:results of a 1-year survey in France. JAMA, 2002, 288 (1):75-81.
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3. |
Thuny F, Di Salvo G, Disalvo G, et al. Risk of embolism and death in infective endocarditis:prognostic value of echocardiography:a prospective multicenter study. Circulation, 2005, 112 (1):69-75.
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San Román JA, López J, Vilacosta I, et al. Prognostic stratification of patients with left-sided endocarditis determined at admission. Am J Med, 2007, 120 (4):369.e1-e7.
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Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis, 2000, 30 (4):633-638.
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Durack DT, Lukes AS, Bright DK. New criteria for diagnosis ofinfective endocarditis:utilization of specific echocardiographic findings.Duke Endocarditis Service. Am J Med, 1994, 96 (3):200-209.
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Netzer RO, Zollinger E, Seiler C, et al. Infective endocarditis:clinical spectrum, presentation and outcome. An analysis of 212 cases 1980-1995. Heart, 2000, 84 (1):25-30.
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Delahaye F, Goulet V, Lacassin F, et al. Characteristics of infective endocarditis in France in 1991. A 1-year survey. Eur Heart J, 1995, 16 (3):394-401.
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Doco-Lecompte XB, AEPEI Study Group. Temporal trends in infectiveendocarditis in the context of prophylaxis guideline modifications:three successive population-based surveys. J Am Coll Cardiol, 2012, 59 (22):1968-1976.
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Castill OJ, Anguita MP, Ramirez A, et al. Long term outcome of infective endocarditis in patients who were not drug addicts:a 10 year study. Heart, 2000, 83:525-530.
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Wang A, Athan E, Pappas PA, et al. Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA, 2007, 297 (12):1354-1361.
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Lopes S, Calvinho P, de Oliveira F, et al. Allograft aortic root replacement in complex prosthetic endocarditis. Eur J Cardiothorac Surg, 2007, 32 (1):126-130.
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13. |
王波, 阎德民, 肖德锦, 等. 感染性心内膜炎的诊断与治疗. 中国胸心血管外科临床杂志, 2010, 17 (1):70-72.
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14. |
Krasopoulos G, David TE, Armstrong S. Custom-tailored valved conduit for complex aortic root disease. J Thorac Cardiovasc Surg, 2008, 135 (1):3-7.
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15. |
Thuny F, Giorgi R, Habachi R, et al. Excess mortality and morbidityin patients surviving infective endocarditis. Am Heart J, 2012, 164 (1):94-101.
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16. |
Kang DH, Kim YJ, Kim SH, et al. Early surgery versus conventional treatment for infective endocarditis. N Engl J Med, 2012, 366 (26):2466-2473.
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- 1. Moreillon P, Que YA. Infective endocarditis. Lancet, 2004, 363:139-149.
- 2. Hoen B, Alla F, Selton-Suty C, et al. Changing profile of infective endocarditis:results of a 1-year survey in France. JAMA, 2002, 288 (1):75-81.
- 3. Thuny F, Di Salvo G, Disalvo G, et al. Risk of embolism and death in infective endocarditis:prognostic value of echocardiography:a prospective multicenter study. Circulation, 2005, 112 (1):69-75.
- 4. San Román JA, López J, Vilacosta I, et al. Prognostic stratification of patients with left-sided endocarditis determined at admission. Am J Med, 2007, 120 (4):369.e1-e7.
- 5. Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis, 2000, 30 (4):633-638.
- 6. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis ofinfective endocarditis:utilization of specific echocardiographic findings.Duke Endocarditis Service. Am J Med, 1994, 96 (3):200-209.
- 7. Netzer RO, Zollinger E, Seiler C, et al. Infective endocarditis:clinical spectrum, presentation and outcome. An analysis of 212 cases 1980-1995. Heart, 2000, 84 (1):25-30.
- 8. Delahaye F, Goulet V, Lacassin F, et al. Characteristics of infective endocarditis in France in 1991. A 1-year survey. Eur Heart J, 1995, 16 (3):394-401.
- 9. Doco-Lecompte XB, AEPEI Study Group. Temporal trends in infectiveendocarditis in the context of prophylaxis guideline modifications:three successive population-based surveys. J Am Coll Cardiol, 2012, 59 (22):1968-1976.
- 10. Castill OJ, Anguita MP, Ramirez A, et al. Long term outcome of infective endocarditis in patients who were not drug addicts:a 10 year study. Heart, 2000, 83:525-530.
- 11. Wang A, Athan E, Pappas PA, et al. Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA, 2007, 297 (12):1354-1361.
- 12. Lopes S, Calvinho P, de Oliveira F, et al. Allograft aortic root replacement in complex prosthetic endocarditis. Eur J Cardiothorac Surg, 2007, 32 (1):126-130.
- 13. 王波, 阎德民, 肖德锦, 等. 感染性心内膜炎的诊断与治疗. 中国胸心血管外科临床杂志, 2010, 17 (1):70-72.
- 14. Krasopoulos G, David TE, Armstrong S. Custom-tailored valved conduit for complex aortic root disease. J Thorac Cardiovasc Surg, 2008, 135 (1):3-7.
- 15. Thuny F, Giorgi R, Habachi R, et al. Excess mortality and morbidityin patients surviving infective endocarditis. Am Heart J, 2012, 164 (1):94-101.
- 16. Kang DH, Kim YJ, Kim SH, et al. Early surgery versus conventional treatment for infective endocarditis. N Engl J Med, 2012, 366 (26):2466-2473.