[感染性心内膜炎：多学科方法治疗261例患者的短期和长期结果]

[Infective endocarditis: short and long-term results in 261 cases managed by a multidisciplinary approach].

作者信息

Braun S, Escalona A, Chamorro G, Corbalán R, Pérez C, Labarca J, Irarrázaval M J, Zalaquett R, Rodríguez J A, Casanegra P

机构信息

Departamento de Enfermedades Cardiovasculares, Hospital Clínico Pontificia Universidad Católica de Chile.

出版信息

Rev Med Chil. 2000 Jul;128(7):708-20.

PMID:11050831

Abstract

BACKGROUND

Early diagnosis, an effective treatment and prompt recognition of complications are essential to improve the prognosis of infective endocarditis (IE).

AIM

To report the results of a multidisciplinary approach to diagnosis and management of patients with IE at the Universidad Católica de Chile Hospital.

PATIENTS AND METHODS

The clinical history, diagnosis, treatment and outcome of 261 episodes (Duke criteria) of IE admitted between January 1980 and January 1999 were analyzed. These included 185 episodes of native, 73 of prosthetic valve and 3 of nonvalvular IE.

RESULTS

Sixty nine percent of patients were men and the mean age was 49 +/- 16 years. Seventy five percent had a definite diagnosis of IE (Duke). S. viridans, staphylococci and enterococci together constituted 85% of the isolated bacterial strains. Twenty seven had culture-negative IE, related to a high incidence of antibiotic therapy prior to diagnosis. Transesophageal echocardiography was performed in 102 cases and it detected vegetations in 91% of aortic and 96% of mitral IE, rupture or prosthesis dehiscence in 67% of aortic and 52% of mitral IE and abscesses in 51% of aortic and 15% of mitral IE. Fifty one percent developed heart failure and 34% had embolic events. S. aureus IE was associated to a higher incidence of embolic events, complications which contraindicated surgery and increased mortality rate (27%). Of all patients, 40% were treated exclusively with antibiotics, 52% were operated on and 8% had surgical indication but were nonoperable because of serious complications. The overall mortality was 16.3%: 13% in the medical, 9% in the surgical and 81% in the non-operable groups. The type of treatment and mortality rates did not differ between IE of native valves and prosthetic valves. Long term follow up showed survival rates of 73% at 5 years and 66% at 10 years.

CONCLUSION

A multidisciplinary approach may be very helpful to improve the prognosis of IE.

摘要

背景

早期诊断、有效治疗以及及时识别并发症对于改善感染性心内膜炎（IE）的预后至关重要。

目的

报告智利天主教大学医院对IE患者进行多学科诊断和管理的结果。

患者与方法

分析了1980年1月至1999年1月期间收治的261例符合杜克标准的IE发作的临床病史、诊断、治疗及转归情况。其中包括185例原发性IE、73例人工瓣膜IE和3例非瓣膜性IE。

结果

69%的患者为男性，平均年龄为49±16岁。75%的患者确诊为IE（杜克标准）。草绿色链球菌、葡萄球菌和肠球菌共占分离出细菌菌株的85%。27例为血培养阴性的IE，与诊断前抗生素治疗的高发生率有关。102例患者接受了经食管超声心动图检查，其中91%的主动脉瓣IE和96%的二尖瓣IE检测到赘生物，67%的主动脉瓣IE和52%的二尖瓣IE检测到破裂或人工瓣膜裂开，51%的主动脉瓣IE和15%的二尖瓣IE检测到脓肿。51%的患者发生心力衰竭，34%的患者发生栓塞事件。金黄色葡萄球菌性IE与较高的栓塞事件发生率、手术禁忌的并发症及死亡率增加（27%）相关。所有患者中，40%仅接受抗生素治疗，52%接受手术治疗，8%有手术指征但因严重并发症无法手术。总体死亡率为16.3%：药物治疗组为13%，手术治疗组为9%，无法手术组为81%。原发性瓣膜IE和人工瓣膜IE的治疗类型及死亡率无差异。长期随访显示，5年生存率为73%，10年生存率为66%。