摘要
目的对感染性心内膜炎(IE)合并脑出血患者的临床特征进行总结分析。方法回顾性分析徐州医科大学附属医院2010年1月至2021年12月诊断的15例IE合并脑出血患者的临床资料,对其临床特点进行分析,包括起病方式、头颅影像学特征、合并疾病、超声心动图检查、血液学检查、病原学检查、胸部CT、脑脊液特点以及患者的治疗方式、预后等。结果IE患者合并脑出血时为急性或亚急性起病,头颅CT检查示脑出血容易出现在脑叶。IE患者可合并有风湿性心脏病、先天性心脏病或免疫系统疾病等。超声心动图检查可明确心腔内赘生物的发生部位、瓣叶毁损情况及引起的血流动力学改变。血液学检查可见血象升高、血沉增快,病原学检查常可检出金黄色葡萄球菌或草绿色链球菌。胸部CT可见肺部感染,脑脊液检查可见炎性改变。IE的治疗主要是给予足量足疗程的抗生素,合并瓣膜损坏时可行瓣膜置换术,本组病例病死率为3/15。结论当年轻患者出现脑叶出血,合并头痛、发热、先天性心脏病及风湿性心脏病时应想到IE并发脑出血的可能。IE合并脑出血时预后不好,病死率较高。
Objective To summarize and analyze the clinical characteristics of patients with infective endocarditis(IE)complicated with cerebral hemorrhage.Methods The clinical data of 15 IE patients with intracerebral hemorrhage diagnosed in the Affiliated Hospital of Xuzhou Medical University from January 2010 to December 2021 were analyzed retrospectively,and their clinical characteristics were analyzed,including the mode of onset,cranial imaging characteristics,associated diseases,echocardiography,hematology,etiology,chest computed tomography(CT),cerebrospinal fluid characteristics,treatment methods and prognosis of patients.Results Cerebral hemorrhage in IE patients were acute or subacute onset.Head CT scanning showed that cerebral hemorrhage usually occurred in the brain lobe,can be combined with rheumatic heart disease,congenital heart defect or immune system diseases,etc.Ultrasonic cardiogram can be used to determine the location of vegetations in the heart cavity,the damage of the valve and the hemodynamic changes.The hematologic examination showed elevated hemogram and increased erythrocyte sedimentation rate.Staphylococcus aureus or streptococcus viridans were often detected on the etiological examination.Lung infection was often seen on a chest CT,and inflammatory changes were seen in the cerebrospinal fluid.IE was treated with sufficient course of antibiotics and valve replacement with valve damage.The case fatality rate was 3/15.Conclusions Young patients presented with lobar hemorrhage,headache,fever and rheumatic heart disease should be thought of the possibility of IE combined with cerebral hemorrhage.IE with intracerebral hemorrhage has a poor prognosis and a high mortality.
作者
王晓瑛
陈静
张作慧
杨新新
Wang Xiaoying;Chen Jing;Zhang Zuohui;Yang Xinxin(Department of Ultrasonic Cardiogram,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,China;Department of Neurology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,China)
出处
《中国医师杂志》
CAS
2022年第10期1460-1463,1467,共5页
Journal of Chinese Physician
基金
国家自然科学基金(81671269)
江苏省青年医学重点人才基金(QNRC2016789)
作者简介
通信作者:杨新新,Email:neurologyang@126.com
