感染性心内膜炎进展及指南周建庆课件.ppt

感染性心内膜炎进展及指南 宁波市医疗中心李惠利医院 周建庆 流行病学 年发病率十万分之五，随年龄增大发病率上升，我国年发病约5~8万例。 危险因素：人工瓣膜、风心、先心、老年退行性主动脉瓣病变、二尖瓣脱垂、介入治疗、血透、牙科手术、静脉留置。 病 理 3/4病人原有器质性心脏病基础。内皮细胞破坏，血小板及纤维蛋白积聚，细菌产生粘附基质分子，细菌粘附繁殖。见下图： 图1、心内膜炎发生步骤 表1 感染性心内膜炎并发症 Congestive heart failure 50~60% AI＞MR ＞TR Embolization 20~25% Mitral ＞Aortic valve CVA 15% Other emboli Limb 2~3% Mesenteric 2% Splenic 2~3% Glomerulonephritis 15~25% Anular abscess 10~15% Myocotic aneurysm 10~15% Conduction system involvement 5~10% CNS abscess 3~4% Other less common complications 1~2% Pericarditis Myocarditis Myocardial infarction intracardiac fistula Metastatic abscess 诊 断 关键是具有高度的临床警惕性 Table 5 Criteria that should raise suspicion of IE ●?High clinical suspision (rugent indication for echocardiographic screening and possibly hospital admission) ○ new valve lesion/(regurgitant)murmur ○ embolic enent(s) of unknown origin (esp.cerebral and renal infarction) ○ sepsis of unknown origin ○ haematuria, goumerulonephritis, and suspected renal infarction ○ ‘fever’plus █ prosthetic material inside the heart