34例由右侧感染性心内膜炎引起的脓毒性肺栓塞患者的临床表现及临床病程。

Liu Shuang, Xie Jiang, Chen Yong, Yang Jinghua, Zhang Jianqun, Meng Xu, Liu Yinglong

Department of Pulmonary and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China. Email:

Department of Pulmonary and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.

Chin Med J (Engl). 2014;127(15):2735-9.

BACKGROUND

Misdiagnosis and missed diagnosis of septic pulmonary embolism (SPE), a rare disease, occurs among the patients with right heart infective endocarditis. The purpose of this study was to analyze the characteristics of SPE and improve the early diagnosis and treatment.

METHODS

We retrospectively studied 34 patients with septic pulmonary embolism caused by right-sided infective endocarditis who were seen from June 1, 2002 to June 1, 2013. We reviewed the medical records and radiological images of these cases and extracted the following information: age, gender, and symptoms, physical examination, laboratory findings, transthoracic echocardiography (TTE) results, treatment information, comorbid medical conditions, and outcomes. Microbiological samples were collected and processed according to well-established and published guidelines.

RESULTS

We identified basic heart disease in 97.1% of the patients. A high proportion of the right-sided infective endocarditis patients had congenital heart defects (82.4%); predominantly, ventricular septal defects. Clinical symptoms were fever (97.1%), cardiac murmurs (94.1%) and fatigue (88.2%). Respiratory symptoms included cough (58.8%), pleuritic chest pain (47.1%) and hyoxemia (52.9%). Positive blood cultures were grown from 35.2% of patients and 50.0% were caused by staphylococcal species. Chest X-rays or CT examinations detected patchy infiltrates and/or nodules in all cases. Transthoracic echocardiography demonstrated infectious foci of the right-side heart in all cases. Parenteral antibiotics were administered for all, and cardiac surgery was carried out for 76.5% of patients with an effective rate of 82.3%.

CONCLUSIONS

SPE lacks characteristic clinical manifestation. Congenital heart disease is a common risk of SPE. Most patients with SPE have a good prognosis as long as early diagnosis and proper treatment can be provided.

背景

脓毒性肺栓塞（SPE）是一种罕见疾病，在右心感染性心内膜炎患者中会发生误诊和漏诊。本研究的目的是分析SPE的特征并改善早期诊断和治疗。

方法

我们回顾性研究了2002年6月1日至2013年6月1日期间收治的34例由右侧感染性心内膜炎引起的脓毒性肺栓塞患者。我们查阅了这些病例的病历和影像学资料，并提取了以下信息：年龄、性别、症状、体格检查、实验室检查结果、经胸超声心动图（TTE）结果、治疗信息、合并的内科疾病及预后。根据既定的和已发表的指南收集并处理微生物样本。

结果

我们发现97.1%的患者有基础心脏病。右侧感染性心内膜炎患者中很大一部分有先天性心脏缺陷（82.4%）；主要是室间隔缺损。临床症状包括发热（97.1%）、心脏杂音（94.1%）和乏力（88.2%）。呼吸系统症状包括咳嗽（58.8%）、胸膜炎性胸痛（47.1%）和低氧血症（52.9%）。35.2%的患者血培养呈阳性，50.0%由葡萄球菌属引起。胸部X线或CT检查在所有病例中均检测到斑片状浸润和/或结节。经胸超声心动图在所有病例中均显示右侧心脏的感染灶。所有患者均给予静脉抗生素治疗，76.5%的患者接受了心脏手术，有效率为82.3%。