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[感染性心内膜炎:预防、诊断及治疗的最新进展]

[Infective endocarditis : Update on prophylaxis, diagnosis, and treatment].

作者信息

Dietz S, Lemm H, Janusch M, Buerke M

机构信息

Medizinische Klinik II, Kardiologie, Angiologie und Internistische Intensivmedizin, St. Marien-Krankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Deutschland.

出版信息

Med Klin Intensivmed Notfmed. 2016 May;111(4):267-78. doi: 10.1007/s00063-016-0161-0. Epub 2016 May 10.

Abstract

The diagnosis of infective endocarditis is often delayed in clinical practice. Timely diagnosis and rapid antibiotic treatment is important. Higher age of patients, new risk factors, and increasing use of intravascular prosthetic materials resulted in changes in microbial spectrum. Nowadays, nonspecific symptoms, critically ill patients, and immunocompromised patients require a high level of diagnostic expertise.The new guidelines from the European Society of Cardiology provide various diagnostic algorithms and recommendations for antibiotic treatment. The new guidelines also recommend the formation of an endocarditis team with various medical disciplines, including a cardiac surgeon, to improve treatment because in half of all endocarditis patients, antibiotic therapy alone does not result in successful management of the infection. If complications occur, early surgical treatment should be performed.In this overview, diagnostic strategies and therapeutic approaches for the treatment of infectious endocarditis according to the current guidelines and aspects of surgical treatment are provided.

摘要

在临床实践中,感染性心内膜炎的诊断常常被延误。及时诊断和迅速进行抗生素治疗很重要。患者年龄增大、新的危险因素以及血管内假体材料使用的增加导致了微生物谱的变化。如今,非特异性症状、重症患者以及免疫功能低下的患者需要高水平的诊断专业知识。欧洲心脏病学会的新指南提供了各种诊断算法以及抗生素治疗的建议。新指南还建议组建一个由包括心脏外科医生在内的多个医学学科组成的心内膜炎治疗团队,以改善治疗效果,因为在所有心内膜炎患者中,有一半仅靠抗生素治疗无法成功控制感染。如果出现并发症,应尽早进行手术治疗。在本综述中,将根据当前指南提供感染性心内膜炎的诊断策略和治疗方法以及手术治疗的相关方面。

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