95例先天性心脏病合并感染性心内膜炎患者临床特征分析

发布时间：2018-03-08 13:37

本文选题：感染性心内膜炎　切入点：先天性心脏病　出处：《北京协和医学院》2017年硕士论文　论文类型：学位论文

【摘要】：[目的]:总结先天性心脏病相关的感染性心内膜炎的临床特征,以揭示其临床特点,提高对先天性心脏病相关的感染性心内膜炎的认识。[方法]:检索出2010年1月至2017年5月期间在北京协和医院住院的,出院诊断中含“先天性心脏病”和“感染性心内膜炎”的患者,对其中符合Duke修订标准的、先天性心脏病相关的95例感染性心内膜炎患者进行分析,总结其人口学特征、临床特征、诊断方法、病原菌分布、瓣膜受累情况及病理表现。[结果]:1、2010年1月至2017年5月期间于我院住院治疗的符合Duke修订标准的、先天性心脏病相关的感染性心内膜炎患者共95例,平均年龄(37.7土 13.3)岁(14～66岁),男64例,平均年龄(37.4± 13.9)岁,女31例,平均年龄(38.4±12.0)岁,男女性别比为2.06。2、在95例先心病相关的感染性心内膜炎患者中最常见的先心病类型是主动脉瓣二叶瓣畸形,共35例(占36.8%),其次为室间隔缺损,共28例(占29.5%)。3、血培养阳性者66例(占69.5%),最常见的致病菌为链球菌属,其中草绿色链球菌最多(n=11例,占14.9%)。4、经胸超声心动图检查阳性者80例(占84.2%),15例阴性患者中4例行经食管超声心动图,分别在二尖瓣(9*3mm)、主动脉瓣(11*1mm)、主肺动脉、左肺动脉与主肺动脉分叉处(20*17mm)探及赘生物;赘生物平均大小为(14.7±8.54)mm,最小 4.5mm,最大 50mm。5、95例患者中81例行手术治疗,死亡2例,14例行内科保守治疗,死亡1例,总病死率为3.2%。6、常见并发症有心脏并发症(n=81例)、肾损害(n=5例)和栓塞(n=21例)。[结论]:1、建议加强对先天性心脏病筛查,早期修复手术以降低IE风险;2、与结构性心脏病相比,先心病相关IE更易出现右心受累;3、内科保守治疗欠佳者,建议早期手术治疗,术前、术后均应给予充分、足疗程抗生素治疗。
[Abstract]:[objective]: to summarize the clinical features of infective endocarditis associated with congenital heart disease in order to reveal its clinical characteristics. To raise the awareness of infective endocarditis associated with congenital heart disease. Patients with "congenital heart disease" and "infective endocarditis" in the diagnosis of congenital heart disease were analyzed in 95 patients with congenital heart disease associated with infective endocarditis who met the revised criteria of Duke, and their demographic characteristics were summarized. Clinical features, diagnostic methods, distribution of pathogenic bacteria, valvular involvement and pathological findings. [results] from January 2010 to May 2017, the patients admitted to our hospital from January 2010 to May 2017 met the revised criteria of Duke. There were 95 patients with congenital heart disease associated with infective endocarditis. The mean age was 37.7 卤13.3) years (64 males, mean age 37.4 卤13.9), 31 females (38.4 卤12.0) years old. The sex ratio between male and female was 2.06.2. The most common type of congenital heart disease in 95 patients with infective endocarditis associated with congenital heart disease was aortic two-lobe valve malformation (35 cases, 36.8%), followed by ventricular septal defect (VSD). There were 28 cases (29.5%) and 66 cases (69.5%) positive in blood culture. The most common pathogenic bacteria were streptococcus, among which 11 cases were streptococcus graminearum. 80 cases (84.2%) were positive by transthoracic echocardiography (84.2%). Transesophageal echocardiography was performed in 4 patients with mitral valvulosus (9mm), aortic valve (111mm), main pulmonary artery, left pulmonary artery (left pulmonary artery) and main pulmonary artery (2017mm). The mean size of neoplasm was 14.7 卤8.54mm, the smallest was 4.5mm, the maximum was 50mm. 5mm. Among 95 patients, 81 cases were treated surgically, 2 cases died (14 cases) received conservative medical treatment, and 1 case died. The total mortality was 3.2.6The common complications were cardiac complications (81 cases), renal damage (5 cases) and embolization (21 cases). [conclusion] 1. It is suggested to strengthen screening for congenital heart disease and early repair surgery to reduce the risk of IE, compared with structural heart disease. Congenital heart disease related IE is more likely to appear right heart involvement 3, internal medicine conservative treatment is poor, early surgical treatment, preoperative and postoperative should be given sufficient, full course of antibiotic treatment.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.1;R542.41

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