感染性心内膜炎临床研究附136例临床病例
摘要
目的:总结感染性心内膜炎(IE)的临床特点并探讨治疗方法。
方法:收集广西医科大学第一附属医院2000年1月～2011年1月确诊IE的患者136例。分析患者的一般情况、临床表现、实验室和器械检查结果、治疗方案及早期预后等相关资料。按照抗生素+手术治疗和单纯抗生素治疗分成两组进行对比,分析其早期疗效。其中经抗生素+手术治疗患者106例,单纯抗生素治疗患者30例。
结果:1.全组IE患者平均发病年龄为34.9岁。2. IE临床表现多样化,无特异性。3.超声心动图检查阳性率高于血培养。4.早期诊断、有效抗生素治疗、及时手术治疗,明显减少并发症及死亡率。全组早期死亡率为14.71%。单纯抗生素治疗组并发急性心衰,严重心率失常,严重的栓塞率高于手术组。单纯抗生素治疗30例中18例(60%)死亡,手术治疗106例中8例(10.81%)死亡。5.全组病例中抗生素+手术治疗组与单纯抗生素治疗组的发病年龄、性别分布、临床表现方面差异无统计学意义(p>0.05)。在基础心脏疾病、抗生素使用、并发症、预后,抗生素+手术治疗组与单纯抗生素治疗组之间差异有统计学意义(p<0.05),IE明确诊断经抗生素有效控制感染后及时手术减少并发症发生且预后优于单纯抗生素治疗。
结论:
1. IE致病菌的种类增多,临床表现无特异性。
2.单纯抗生素治疗IE抗生素使用时间过长,及时手术可明显缩短抗生素使用时间。
3.抗生素治疗同时及时外科治疗预后明显优于单纯抗生素治疗。
Objective: To summarize of infective endocarditis (IE) and to explore the clinical features of treatment and prognostic factors. Methods: 136 cases with IE from January 2000 to January 2011 were retrospectively analysized by patients’history, clinical symptoms, results of laboratory tests, diagnosis, therapy and other related indexes. In accordance with the surgery and divided into two groups of non-surgical treatment compared to analyze the early results. Of which 74 cases surgically treated patients, 59 patients with non-surgical treatment.
Results: The age of onset was (33±4.3) year. The results of Blood tests showed disorders .Clinical manifestations are various. The overall early mortality rate was 14.71%. Non-surgical treatment group after treatment of acute heart failure, serious arrhythmias, severe thrombosis was higher than surgical group, 59 cases of non-surgical treatment in 12 cases (20.34%) died, 74 patients in the surgical treatment of 8 patients (10.81%) died. 5. All the patients in age, sex distribution, antibiotic treatment, clinical presentation, Difference was statistically significant (p <0.05), IE diagnosis prognosis after surgery than medical treatment in time.
Conclusion: In recent years significantly increased in patients with IE, the types of pathogens increasing , and atypical clinical manifestations. Individual timely surgical treatment and surgery in myocardial protection, perioperative treatment plays an important role in reducing mortality. Surgical treatment is better than conservative medical treatment.
方法:收集广西医科大学第一附属医院2000年1月～2011年1月确诊IE的患者136例。分析患者的一般情况、临床表现、实验室和器械检查结果、治疗方案及早期预后等相关资料。按照抗生素+手术治疗和单纯抗生素治疗分成两组进行对比,分析其早期疗效。其中经抗生素+手术治疗患者106例,单纯抗生素治疗患者30例。
结果:1.全组IE患者平均发病年龄为34.9岁。2. IE临床表现多样化,无特异性。3.超声心动图检查阳性率高于血培养。4.早期诊断、有效抗生素治疗、及时手术治疗,明显减少并发症及死亡率。全组早期死亡率为14.71%。单纯抗生素治疗组并发急性心衰,严重心率失常,严重的栓塞率高于手术组。单纯抗生素治疗30例中18例(60%)死亡,手术治疗106例中8例(10.81%)死亡。5.全组病例中抗生素+手术治疗组与单纯抗生素治疗组的发病年龄、性别分布、临床表现方面差异无统计学意义(p>0.05)。在基础心脏疾病、抗生素使用、并发症、预后,抗生素+手术治疗组与单纯抗生素治疗组之间差异有统计学意义(p<0.05),IE明确诊断经抗生素有效控制感染后及时手术减少并发症发生且预后优于单纯抗生素治疗。
结论:
1. IE致病菌的种类增多,临床表现无特异性。
2.单纯抗生素治疗IE抗生素使用时间过长,及时手术可明显缩短抗生素使用时间。
3.抗生素治疗同时及时外科治疗预后明显优于单纯抗生素治疗。
Objective: To summarize of infective endocarditis (IE) and to explore the clinical features of treatment and prognostic factors. Methods: 136 cases with IE from January 2000 to January 2011 were retrospectively analysized by patients’history, clinical symptoms, results of laboratory tests, diagnosis, therapy and other related indexes. In accordance with the surgery and divided into two groups of non-surgical treatment compared to analyze the early results. Of which 74 cases surgically treated patients, 59 patients with non-surgical treatment.
Results: The age of onset was (33±4.3) year. The results of Blood tests showed disorders .Clinical manifestations are various. The overall early mortality rate was 14.71%. Non-surgical treatment group after treatment of acute heart failure, serious arrhythmias, severe thrombosis was higher than surgical group, 59 cases of non-surgical treatment in 12 cases (20.34%) died, 74 patients in the surgical treatment of 8 patients (10.81%) died. 5. All the patients in age, sex distribution, antibiotic treatment, clinical presentation, Difference was statistically significant (p <0.05), IE diagnosis prognosis after surgery than medical treatment in time.
Conclusion: In recent years significantly increased in patients with IE, the types of pathogens increasing , and atypical clinical manifestations. Individual timely surgical treatment and surgery in myocardial protection, perioperative treatment plays an important role in reducing mortality. Surgical treatment is better than conservative medical treatment.
引文
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