预防Q热心内膜炎：住院Q热患者心脏评估综述

Hess I M, Massey P D, Durrheim D N, O'Connor S, Graves S R

Public Health Training and Development Branch, NSW Department of Health, Sydney, New South Wales, Australia.

Rural Remote Health. 2011;11(4):1763. Epub 2011 Nov 17.

INTRODUCTION

Acute Q fever is an important zoonotic disease in some parts of rural Australia. Q Fever can lead to chronic disease such as endocarditis, this complication occurring more commonly in patients with underlying heart valve pathology or an impaired immune system. Untreated Q fever endocarditis has a high mortality rate, but even with appropriate therapy, 10% of patients will die. Cardiac assessment can identify patients at risk. The aim of this review was to examine recorded cardiac assessment of hospitalised Q fever patients within the regional area of Hunter New England (HNE), New South Wales (NSW).

METHODS

Medical records of patients with Q fever admitted to hospitals in HNE during the period 2005-2009 were identified through the NSW Notifiable Diseases Database and the NSW Inpatient Statistics Collection. A standardised medical record review tool was used to undertake the review.

RESULTS

Eighty-nine records were reviewed. Over 50% of patients were admitted to a district hospital staffed by local GPs. Cardiac assessment was not routinely documented and for 91% there was no record of a cardiac history being taken. Approximately 25% had no record of a cardiac physical examination and only 6 cases had a record of a complete cardiac examination.

CONCLUSION

Q Fever remains an important disease in some parts of rural Australia. Q Fever endocarditis is a serious sequel to acute Q fever and underlying heart valve pathology. Due to its indolent progression and poor outcome when diagnosis is delayed, a thorough cardiac assessment of all patients with suspected or confirmed Q fever is important. The level of documentation of cardiac assessment for Q fever patients is of concern because it may indicate cardiac assessments were not performed. General practitioners, especially in rural and regional areas, are encouraged to conduct cardiac assessments for all patients with acute Q fever to identify patients at risk of developing Q fever endocarditis.

引言

急性Q热是澳大利亚农村部分地区一种重要的人畜共患病。Q热可导致慢性疾病，如心内膜炎，这种并发症在有潜在心脏瓣膜病变或免疫系统受损的患者中更常见。未经治疗的Q热心内膜炎死亡率很高，但即使经过适当治疗，仍有10%的患者会死亡。心脏评估可识别有风险的患者。本综述的目的是检查新南威尔士州（NSW）亨特新英格兰（HNE）地区住院Q热患者的心脏评估记录。

方法

通过新南威尔士州法定传染病数据库和新南威尔士州住院患者统计数据收集，确定2005年至2009年期间在HNE医院住院的Q热患者的病历。使用标准化的病历审查工具进行审查。

结果

审查了89份病历。超过50%的患者被收治到由当地全科医生配备人员的地区医院。心脏评估未常规记录，91%的患者没有采集心脏病史的记录。约25%的患者没有心脏体格检查记录，只有6例有完整心脏检查记录。

结论

Q热在澳大利亚农村部分地区仍然是一种重要疾病。Q热心内膜炎是急性Q热和潜在心脏瓣膜病变的严重后遗症。由于其进展缓慢且诊断延迟时预后不良，对所有疑似或确诊Q热的患者进行全面心脏评估很重要。Q热患者心脏评估的记录水平令人担忧，因为这可能表明未进行心脏评估。鼓励全科医生，尤其是农村和地区的全科医生，对所有急性Q热患者进行心脏评估，以识别有发展为Q热心内膜炎风险的患者。