先心病合并感染性心内膜炎的防治_伍伟锋演示文稿.pptVIP

先心病合并感染性心内膜炎的防治 ;IE的发病率 ;Characteristics of Children Hospitalized With Infective Endocarditis. Circulation. 2009;119:865-870.;;1480例IE中有心脏病662例(45%) :先心病81%, 人工瓣膜8%, 风心病5%;感染性心内膜炎特点分析(附119例报告)心血管病杂志2007年4月第23卷第4期(华中科技大学同济医学院附属同济医院心内科);儿童感染性心内膜炎174例临床分析（中国实用儿科杂志2006年6月第21卷第6期） ;The spectrum of adult congenital heart disease in Europe: morbidity and mortality in a 5 year follow-up period. European Heart Journal (2005) 26, 2325–2333;Causative Organism Influences Clinical Profile and Outcome of Infective Endocarditis in Pediatric Patients and Adults With Congenital Heart Disease.Circ J 2005; 69: 1266–1270.;IE流行病学的变迁 ;Conclusions: Cardiac intervention in children with CHD does not increase the risk for IE. Postinterventional IE in children with CHD is strongly linked to implantation of foreign material, especially of pacemaker.;;封堵术后IE;Circulation 2008;117;e326-e327;封堵术前的感染史 有２例病人封堵术前有咽炎发热病史，尽都进行抗菌素治疗，并且体温正常１周后手术。但２病人分别于术后２天、１个半月再次发热、发展为IE。 封堵术后残余分流 Latson等用PDA动物模型实验研究发现有明显残余分流者比完全无残余分流者容易发生封堵术后IE;封堵术后IE的临床表现 ８例个案报道患者首发症状均是发热，其中７例是持续发热，１例是间歇发热。有明显心脏杂音有３例 封堵术后IE的临床诊断 病人有封堵术的病史，按照DUKE诊断标准(12)，符合2个主要标准，或1个主要标准和3个次要标准，或5个次要标准，即可以确诊为封堵术后IE。其中关键问题是血细菌培养及心脏经胸超声心动图（TTE）或经食道超声心动图（TEE）的检查;;1480例IE 中有明确病原菌632例：Staphylococcus aureus(金黄色葡萄球菌) (57%), viridans group of streptococci (链球菌)(20%);先心病IE预防措施;;ESC GUIDLINE ON IE 2009;表2：根据操作的类型推荐预防性使用抗生素的高危患者;表3 牙医高危操作推荐预防性使用抗生素 ;抗生素治疗的原则与方法 ;ESC GUIDLINE ON IE 2009;;;预后;Characteristics of Children Hospitalized With Infective Endocarditis. Circulation. 2009;119:865-870;Long-term outcome of infective endocarditis: A study on patients surviving over one year after the initial episode treated in a Finnish teaching hospital during 25 years.BMC Infectious Diseases 2008, 8:49;Long-term Outcome of Infective Endocarditis in Non–Intravenous Drug Users.Mayo Clin Proc. 2008;83(11): 1213-1217.;谢谢!